Provider Demographics
NPI:1710921432
Name:DARGIS, THERESA B (PAC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:B
Last Name:DARGIS
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 1:43 W RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1711
Mailing Address - Country:US
Mailing Address - Phone:610-226-6200
Mailing Address - Fax:610-226-6201
Practice Address - Street 1:316 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8807
Practice Address - Country:US
Practice Address - Phone:302-234-4000
Practice Address - Fax:302-466-9701
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1710924321Medicaid
DE1710924321Medicaid