Provider Demographics
NPI:1821296302
Name:MAILE, KRISTIN JULIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JULIA
Last Name:MAILE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 STURBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2769
Mailing Address - Country:US
Mailing Address - Phone:570-575-1418
Mailing Address - Fax:
Practice Address - Street 1:2400 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1700
Practice Address - Country:US
Practice Address - Phone:215-830-8700
Practice Address - Fax:215-830-8715
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053024363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical