Provider Demographics
NPI:1639135791
Name:GEORGALAS, MARIA (PAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GEORGALAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:MAMOUNAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:484-884-0617
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:3794 HECKTOWN RD STE 130
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2355
Practice Address - Country:US
Practice Address - Phone:610-402-8900
Practice Address - Fax:484-544-0121
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003503L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0891512PBMedicare ID - Type Unspecified
P33464Medicare UPIN