Provider Demographics
NPI:1063404838
Name:DELLWARDT, DARCI L (PA-C)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:L
Last Name:DELLWARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1501 HARRISBURG PIKE STE 5
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7306
Mailing Address - Country:US
Mailing Address - Phone:717-906-1555
Mailing Address - Fax:717-906-1557
Practice Address - Street 1:1501 HARRISBURG PIKE STE 5
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015
Practice Address - Country:US
Practice Address - Phone:717-906-1555
Practice Address - Fax:717-906-1557
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
50056923OtherCAPITAL BLUE CROSS
P00310849OtherRAILROAD MEDICARE
50056923OtherKEYSTONE HEALTH CENTRAL
1958621OtherHIGHMARK BLUE SHIELD
50056923OtherKEYSTONE HEALTH CENTRAL
50056923OtherCAPITAL BLUE CROSS
50056923OtherKEYSTONE HEALTH CENTRAL