Provider Demographics
NPI:1184058364
Name:DAMASO, MARCELINA (ACNP, BC)
Entity type:Individual
Prefix:
First Name:MARCELINA
Middle Name:
Last Name:DAMASO
Suffix:
Gender:F
Credentials:ACNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 HAVERFORD RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2912
Mailing Address - Country:US
Mailing Address - Phone:239-822-9046
Mailing Address - Fax:
Practice Address - Street 1:3039 FOULK RD
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-1701
Practice Address - Country:US
Practice Address - Phone:610-361-0070
Practice Address - Fax:610-361-0071
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430741-1363LA2100X
PASP013827363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA385404ZJJJMedicare PIN