Provider Demographics
NPI:1619227063
Name:BENEDICT, ALISA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:BENEDICT
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 1:105 CORNERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2325
Mailing Address - Country:US
Mailing Address - Phone:724-777-1729
Mailing Address - Fax:
Practice Address - Street 1:1142 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:HOPWOOD
Practice Address - State:PA
Practice Address - Zip Code:15445-2250
Practice Address - Country:US
Practice Address - Phone:724-437-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant