Provider Demographics
NPI:1497351704
Name:MIRAKIAN, LINDSAY MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MORGAN
Last Name:MIRAKIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36304 DELAIRE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-5246
Mailing Address - Country:US
Mailing Address - Phone:215-360-9375
Mailing Address - Fax:
Practice Address - Street 1:2010 W CHESTER PIKE STE 406
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2739
Practice Address - Country:US
Practice Address - Phone:610-619-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant