Provider Demographics
NPI:1962014621
Name:NGAN, SERENA (PA-C)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:NGAN
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 1:240 CETRONIA RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9263
Mailing Address - Country:US
Mailing Address - Phone:484-503-4500
Mailing Address - Fax:
Practice Address - Street 1:1600 ST LUKES BLVD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5671
Practice Address - Country:US
Practice Address - Phone:484-503-4500
Practice Address - Fax:484-503-4501
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA00000390200000X
PAMA061907363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program