Provider Demographics
NPI:1215927561
Name:BOB, DEBORAH J (APRN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BOB
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BANFITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:2ND FLR, EAST PAVILION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-615-4949
Mailing Address - Fax:
Practice Address - Street 1:104 PHEASANT RUN
Practice Address - Street 2:SUITE 128
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3439
Practice Address - Country:US
Practice Address - Phone:215-860-3344
Practice Address - Fax:215-860-8950
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075458Medicare ID - Type Unspecified
Q04473Medicare UPIN
PA095503LWHMedicare ID - Type Unspecified