Provider Demographics
NPI:1619529559
Name:CARDIE, ROSEMARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:CARDIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:621 AUTUMN LANE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-739-7236
Mailing Address - Fax:
Practice Address - Street 1:501 W. 14TH ST.
Practice Address - Street 2:
Practice Address - City:WILLMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-320-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant