Provider Demographics
NPI:1467824722
Name:CARNESI, VICTORIA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:CARNESI
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:825 OLD LANCASTER ROAD
Practice Address - Street 2:SUITE #250
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3239
Practice Address - Country:US
Practice Address - Phone:610-542-3300
Practice Address - Fax:610-542-3320
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2016-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA057693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant