Basic Information
Provider Information
NPI: 1376745836
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MACQUEEN
FirstName: KARYN
MiddleName: ELIZABETH
NamePrefix: MISS
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224 WILLITS WAY
Address2: RMH EMERGENCY MEDICINE PHYSICIANS
City: GLEN MILLS
State: PA
PostalCode: 193421458
CountryCode: US
TelephoneNumber: 6108913214
FaxNumber:  
Practice Location
Address1: 1068 W BALTIMORE PIKE
Address2:  
City: MEDIA
State: PA
PostalCode: 190635104
CountryCode: US
TelephoneNumber: 6108913214
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 03/06/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA052641PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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