Provider Demographics
NPI:1952779084
Name:QUAGLIA, MARIAN HORNUNG (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:HORNUNG
Last Name:QUAGLIA
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 1:1742 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3631
Mailing Address - Country:US
Mailing Address - Phone:215-639-8773
Mailing Address - Fax:
Practice Address - Street 1:801 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-4212
Practice Address - Country:US
Practice Address - Phone:215-787-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000686L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical