Provider Demographics
NPI:1639570823
Name:LONERGAN, MALIA ALLEGRA (PA-C)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:ALLEGRA
Last Name:LONERGAN
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 1:3710 HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-4646
Mailing Address - Country:US
Mailing Address - Phone:336-299-6242
Mailing Address - Fax:336-299-7862
Practice Address - Street 1:3710 HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4646
Practice Address - Country:US
Practice Address - Phone:336-299-6242
Practice Address - Fax:336-299-7862
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical