Provider Demographics
NPI:1720469323
Name:DEMBROSKY, CARALYN ANN
Entity Type:Individual
Prefix:MS
First Name:CARALYN
Middle Name:ANN
Last Name:DEMBROSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2807
Mailing Address - Country:US
Mailing Address - Phone:610-876-6180
Mailing Address - Fax:
Practice Address - Street 1:170 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-299-4871
Practice Address - Fax:717-391-2494
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363A00000X, 363AS0400X
PAMA056817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical