Provider Demographics
NPI:1588702336
Name:CONAWAY, ANDREA CHRISTINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:CONAWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-1611
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:609-396-2600
Mailing Address - Fax:609-396-3600
Practice Address - Street 1:750 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4143
Practice Address - Country:US
Practice Address - Phone:609-394-6013
Practice Address - Fax:609-815-7529
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00053100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122884M5NMedicare PIN