Provider Demographics
NPI:1841514890
Name:DORSEY-FUNK, BEVERLY ANN (PAC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:DORSEY-FUNK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 HERITAGE CENTER DR STE 116
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1262
Mailing Address - Country:US
Mailing Address - Phone:215-794-2462
Mailing Address - Fax:215-794-8496
Practice Address - Street 1:2325 HERITAGE CENTER DR STE 116
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1262
Practice Address - Country:US
Practice Address - Phone:215-794-2462
Practice Address - Fax:215-794-8496
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical