Basic Information
Provider Information
NPI: 1497053151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRIGG
FirstName: KAREN
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CORINI
OtherFirstName: KAREN
OtherMiddleName: J.
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PA-C
OtherLastNameType: 1
Mailing Information
Address1: 100 E LANCASTER AVE
Address2: MEZZANINE LEVEL
City: WYNNEWOOD
State: PA
PostalCode: 190963450
CountryCode: US
TelephoneNumber: 4844761000
FaxNumber: 4844769000
Practice Location
Address1: 100 E LANCASTER AVE
Address2: MEZZANINE LEVEL
City: WYNNEWOOD
State: PA
PostalCode: 190963450
CountryCode: US
TelephoneNumber: 4844761000
FaxNumber: 4844769000
Other Information
ProviderEnumerationDate: 03/04/2011
LastUpdateDate: 07/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XMA054924PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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