Provider Demographics
NPI:1881987949
Name:CAVALCANTO, DANA M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:CAVALCANTO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-3505
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:610-382-5900
Mailing Address - Fax:610-382-5918
Practice Address - Street 1:200 STATE STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-521-4112
Practice Address - Fax:610-521-6864
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053609363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
236448XDKMedicare PIN