Provider Demographics
NPI:1760740252
Name:CORMAN, MANDY LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNNE
Last Name:CORMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:LYNNE
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:224 N LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1850
Practice Address - Country:US
Practice Address - Phone:717-242-0196
Practice Address - Fax:717-242-0701
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053630363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102772019Medicaid
PA703141OtherMEDICARE