Provider Demographics
NPI:1558516245
Name:PIE, C ADRIENNE (PA-C)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:ADRIENNE
Last Name:PIE
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 1:50 WOODSIDE RD
Mailing Address - Street 2:#13 CRICKET SQUARE
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1437
Mailing Address - Country:US
Mailing Address - Phone:610-649-3714
Mailing Address - Fax:
Practice Address - Street 1:175 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2212
Practice Address - Country:US
Practice Address - Phone:610-595-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000262L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant