Provider Demographics
NPI:1932353802
Name:GRAMLEY, DEBRA JOAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOAN
Last Name:GRAMLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1205 GRAMPIAN BLVD
Practice Address - Street 2:SUITE3-C
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1978
Practice Address - Country:US
Practice Address - Phone:570-326-4118
Practice Address - Fax:570-326-5533
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA221893OtherMDICARE GROUP MEMBER PTAN