Individual
CARISSA SUSAN MCILWAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25 BALA AVE STE 205, BALA CYNWYD, PA 19004-3215
(610) 667-6363
Mailing address
19 OLD OAKS RD, BRYN MAWR, PA 19010-1024
(610) 564-5739
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
OA002318
PA
Other
Enumeration date
12/10/2018
Last updated
12/10/2018
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