Provider Demographics
NPI:1891853974
Name:APPOLO, BRENDA A (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:APPOLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:LEHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PA-C
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:PCAM 4 SOUTH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-349-8222
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:PCAM 4 SOUTH
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-349-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051194363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ46970Medicare UPIN