Provider Demographics
NPI:1871841569
Name:BUCZACKI, JEANETTE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:MARIE
Last Name:BUCZACKI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3457 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:610-353-6600
Mailing Address - Fax:610-353-3399
Practice Address - Street 1:855 SPRINGDALE DR STE 120
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2836
Practice Address - Country:US
Practice Address - Phone:610-561-6100
Practice Address - Fax:610-524-0133
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2019-07-18
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Provider Licenses
StateLicense IDTaxonomies
PAOA004088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant