Individual
MARY KIMMITT LAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DHSC, PA-C
Contact information
Practice address
97 DARTMOUTH AVE, SWARTHMORE, PA 19081-1617
(610) 996-5416
Mailing address
97 DARTMOUTH AVE, SWARTHMORE, PA 19081-1617
(610) 996-5416
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA002532L
PA
363AM0700X
Medical Physician Assistant
Primary
MA002532L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA002532L
LICENSE
PA
Enumeration date
09/28/2006
Last updated
05/08/2024
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