Provider Demographics
NPI:1659306231
Name:DECHELLIS, PATRICIA OLYMPIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:OLYMPIA
Last Name:DECHELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:OLYMPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD STE 226
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1224
Practice Address - Country:US
Practice Address - Phone:215-710-4460
Practice Address - Fax:215-710-4465
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424600207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA655618OtherHIGHMARK BLUE SHIELD
PA1011067400006Medicaid
PA2332063000OtherKEYSTONE IBC
PAP01515612OtherRAILROAD MEDICARE
PA4769622OtherCIGNA
PA1011067400006Medicaid
PA2332063000OtherKEYSTONE IBC
PA101106740-02OtherAMERICHOICE FRANKFORD
PA655618OtherHIGHMARK BLUE SHIELD
PA452729OtherAETNA CONTRACT
PA34937OtherHEALTH PARTNERS BUCKS
PA30019329OtherKEYSTONE MERCY
PA1011067400001Medicaid
PA1655618OtherPERSONAL CHOICE
PA2332063000OtherKEYSTONE IBC
PA1011067400003Medicaid
PA085391JL1Medicare PIN