Provider Demographics
NPI:1659654838
Name:DITORO, RACHEL ANGELA (PAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANGELA
Last Name:DITORO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BICKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4406
Mailing Address - Country:US
Mailing Address - Phone:215-285-8192
Mailing Address - Fax:
Practice Address - Street 1:1456 FERRY RD STE 402
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2307
Practice Address - Country:US
Practice Address - Phone:215-348-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002953L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical