Provider Demographics
NPI:1538127279
Name:RADELL, MARY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:RADELL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:CARONDELET MEDICAL GROUP
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-872-7265
Mailing Address - Fax:520-872-7929
Practice Address - Street 1:630 N ALVERNON WAY SUITE 251
Practice Address - Street 2:CARONDELET MEDICAL GROUP
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-322-8460
Practice Address - Fax:520-323-5742
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-07-14
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Provider Licenses
StateLicense IDTaxonomies
AZ2064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392712Medicaid
P13876Medicare UPIN
AZ392712Medicaid