Provider Demographics
NPI:1023504743
Name:DINGLASAN, MADELEINE REBECCA (PA-C)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:REBECCA
Last Name:DINGLASAN
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 1:20 DUKE MEDICINE CIR # 1B1C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-2000
Mailing Address - Country:US
Mailing Address - Phone:919-681-8746
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1152316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant