Provider Demographics
NPI:1841286317
Name:MORTIMER, DONNA M (PA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:12265 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:215-856-1060
Practice Address - Street 1:23 BUSTLETON PIKE STE 100
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6446
Practice Address - Country:US
Practice Address - Phone:215-464-9599
Practice Address - Fax:215-464-7865
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051640363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA051640OtherMEDICAL LICENSE NUMBER