Provider Demographics
NPI:1396794897
Name:FLEDERBACH, GRETA (PAC)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:FLEDERBACH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-439-1662
Mailing Address - Fax:610-439-8397
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:STE 203
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-439-1662
Practice Address - Fax:610-439-8397
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical