Provider Demographics
NPI:1417143033
Name:CERATO BOOTH, MICHELLE (PAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CERATO BOOTH
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR CARDIOLOGY CONSULTANTS OF PHILA
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:610-565-2100
Mailing Address - Fax:610-892-0626
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:4TH FLR SUITE 2400 CARDIOLOGY CONSULTANTS OF PHILA
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-565-2100
Practice Address - Fax:610-892-0626
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2023-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001419L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical