Provider Demographics
NPI:1124238134
Name:HARTH, MISTY SUE (MHS, PA-C)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:SUE
Last Name:HARTH
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COTTMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3062
Mailing Address - Country:US
Mailing Address - Phone:215-742-9900
Mailing Address - Fax:215-742-7051
Practice Address - Street 1:700 COTTMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3062
Practice Address - Country:US
Practice Address - Phone:215-742-9900
Practice Address - Fax:215-742-7051
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051997363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088379HGAMedicare ID - Type Unspecified
PAQ36883Medicare UPIN