Provider Demographics
NPI:1982944567
Name:SCANNELL, MARIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:SCANNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:KLEIN SUITE 505
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3030
Mailing Address - Country:US
Mailing Address - Phone:215-456-8242
Mailing Address - Fax:215-456-8058
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:KLEIN SUITE 505
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3030
Practice Address - Country:US
Practice Address - Phone:215-456-8242
Practice Address - Fax:215-456-8058
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA277685Medicare PIN