Individual
MRS. DONNA M MORTIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
23 BUSTLETON PIKE STE 100, FEASTERVILLE TREVOSE, PA 19053-6446
(215) 464-9599
(215) 464-7865
Mailing address
12265 TOWNSEND RD, PHILADELPHIA, PA 19154-1201
(215) 856-1010
(215) 856-1060
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA051640
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA051640
MEDICAL LICENSE NUMBER
PA
Enumeration date
09/21/2005
Last updated
12/05/2017
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