Provider Demographics
NPI:1720050453
Name:MUSCARELLA, DEAN A (DC, PA-C)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:MUSCARELLA
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:793 E BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3223
Practice Address - Country:US
Practice Address - Phone:864-720-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007082L111N00000X
PAMA056731363AS0400X
SC2301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037763OtherBLUE CROSS BLUE SHIELD
PA0017616080003Medicaid
SC2226PAMedicaid
PA251864370OtherALL OTHER INSURANCE CO.
PA311605OtherUPMC
SCSC06082OtherMEDICARE
PAU73308Medicare UPIN
PA251864370OtherALL OTHER INSURANCE CO.