Denise M. Broll-Dalton, PA-C

Key facts

NPI

1508053554

Entity type

Individual (NPI type 1)

Primary specialty

Medical Physician Assistant 363AM0700X

License

MA001026L (PA)

Practice address

1 Crescent Dr
Suite 100
Philadelphia, PA 19112-1015

Phone

(215) 952-9900

Fax

(215) 952-9977

NPI assigned

Oct 3, 2007

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 25, 2016.

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458864000000",
    "number": "1508053554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 S BROAD ST",
            "address_2": "SUITE 100",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191483542",
            "telephone_number": "215-952-9900",
            "fax_number": "215-952-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CRESCENT DR",
            "address_2": "SUITE 100",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191121015",
            "telephone_number": "215-952-9900",
            "fax_number": "215-952-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROLL-DALTON",
        "first_name": "DENISE",
        "middle_name": "M.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-03",
        "last_updated": "2016-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA001026L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

• Kaitlyn Brogan
• Lauren Nicole Brogan, DPT
• Pearl Elizabeth Brogdon
• Christopher Brokus
• Bruno Broll-Barone, PH.D.
• Elise Bromberg, LCSW
• Michael E Bromberg, MD
• Carlene Bronikowski, D.O.
• Rasheedah Bronson-Hicks
• Robert Bronstein, MD

All providers in Philadelphia, PA · Medical Physician Assistant in Pennsylvania