Active NPI
Jenny Lucia Depadua, PA
- Physician Assistant
- Glen Mills, PA
National Provider Identifier
1710041975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C5-0001064
- Practice address
- 1020 Baltimore Pike Ste 300
Glen Mills, PA 19342 - Phone
- (610) 358-2410
- NPI assigned
- Dec 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C5-0001064 | DE | Primary |
Addresses
Primary practice location
1020 Baltimore Pike Ste 300
Glen Mills, PA 19342
Mailing address
PO Box 191
Rockland, DE 19732-0191
Phone (302) 651-4200
Other practice location 1
1600 Rockland Rd
Wilmington, DE 19803-3607
Phone (302) 651-4200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C5-0001064 | DE | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1710041975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191",
"city": "ROCKLAND",
"state": "DE",
"postal_code": "197320191",
"telephone_number": "302-651-4200",
"fax_number": "302-651-4945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 BALTIMORE PIKE STE 300",
"city": "GLEN MILLS",
"state": "PA",
"postal_code": "19342",
"telephone_number": "610-358-2410"
}
],
"practiceLocations": [
{
"address_1": "1600 Rockland Rd",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "DE",
"postal_code": "198033607",
"country_code": "US",
"telephone_number": "302-651-4200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEPADUA",
"first_name": "JENNY",
"middle_name": "LUCIA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-21",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "DE",
"license": "C5-0001064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Mills, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.