Basic Information
| Provider Information | |||||||||
| NPI: | 1467886960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTEFUSCO BELDNER | ||||||||
| FirstName: | GINA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 278 EAGLEVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193411157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105616400 | ||||||||
| FaxNumber: | 6105616401 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 W RIDGE PIKE | ||||||||
| Address2: | |||||||||
| City: | LIMERICK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194681711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102266200 | ||||||||
| FaxNumber: | 6102266201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 12/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | OA003585 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.