Provider Demographics
NPI:1508053554
Name:BROLL-DALTON, DENISE M (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:BROLL-DALTON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2301 S BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3542
Mailing Address - Country:US
Mailing Address - Phone:215-952-9900
Mailing Address - Fax:215-952-9977
Practice Address - Street 1:1 CRESCENT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1015
Practice Address - Country:US
Practice Address - Phone:215-952-9900
Practice Address - Fax:215-952-9977
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2016-03-25
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Provider Licenses
StateLicense IDTaxonomies
PAMA001026L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical