Provider Demographics
NPI:1669578860
Name:HAUGH, DEANNA L (CRN P)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:L
Last Name:HAUGH
Suffix:
Gender:F
Credentials:CRN P
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:MEDICAL STAFF OFFICE 1ST FLR
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8001
Mailing Address - Country:US
Mailing Address - Phone:215-938-3450
Mailing Address - Fax:215-938-3829
Practice Address - Street 1:1844 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4582
Practice Address - Country:US
Practice Address - Phone:215-357-4066
Practice Address - Fax:215-364-2572
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP TPI
PACD4829OtherRAILROAD MEDICARE TPI GROUP
PA1007278000OtherMEDICAID GROUP WITH TEMPLE PHYSICIANS INC