Provider Demographics
NPI:1467690420
Name:MCFADDEN, ANNE CLARK (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CLARK
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:1300 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2701
Practice Address - Country:US
Practice Address - Phone:215-226-8800
Practice Address - Fax:215-226-8819
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20067363A00000X
PAMA-055882363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherTPI RAILROAD MEDICARE GROUP
CAW5352OtherUPIN
PA1007278000OtherPA MEDICAID GROUP
PA597586OtherTPI MEDICARE GROUP