Provider Demographics
NPI:1932139920
Name:LARKIN, MARY ELLEN S (PA -C)
Entity Type:Individual
Prefix:MS
First Name:MARY ELLEN
Middle Name:S
Last Name:LARKIN
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:MS
Other - First Name:MARY ELLEN
Other - Middle Name:S
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:901 W ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1101
Mailing Address - Country:US
Mailing Address - Phone:610-461-6450
Mailing Address - Fax:610-461-1842
Practice Address - Street 1:901 W ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1101
Practice Address - Country:US
Practice Address - Phone:610-461-6450
Practice Address - Fax:610-461-1842
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003393L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
O01646Medicare UPIN
PA074882Medicare ID - Type Unspecified
PA201538YDMTMedicare PIN