Provider Demographics
NPI:1629685714
Name:DRUCKER, ELYSSA C (PA-C)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:C
Last Name:DRUCKER
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 1:12 PENNLYN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1046
Mailing Address - Country:US
Mailing Address - Phone:215-350-2803
Mailing Address - Fax:
Practice Address - Street 1:12 PENNLYN RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-1046
Practice Address - Country:US
Practice Address - Phone:215-350-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA29960138OtherDRIVER'S LICENSE