Provider Demographics
NPI:1750511713
Name:MCGILL, ALICE A T (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A T
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:A
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:51 N. 39TH STREET
Mailing Address - Street 2:MOB 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-2891
Mailing Address - Fax:215-662-6734
Practice Address - Street 1:51 N. 39TH STREET
Practice Address - Street 2:MOB 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-2891
Practice Address - Fax:215-662-6734
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant