Individual provider Active NPI

Maureen Waters

  • Physician Assistant
  • Wynnewood, PA
National Provider Identifier
1962047290
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA066467 Issued in PA
Practice address
100 E Lancaster Avenue
Suite 375 Medical Science Building
Wynnewood, PA 19096-3433
Phone
(610) 645-9093
Fax
(610) 645-9476
NPI assigned
Nov 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA066467 PA Primary
Physician Assistant 363A00000X 024441 NY

Addresses

Primary practice location

100 E Lancaster Avenue
Suite 375 Medical Science Building
Wynnewood, PA 19096-3433

Mailing address

3803 W Chester Pike Ste 160
Newtown Square, PA 19073-2336
Phone (484) 337-1632

Other practice location 1

1000 10th Ave
New York, NY 10019-1147
Phone (610) 781-4682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200505003143 NY Practitioner - Physician Assistant 7911338058 Reassigns benefits to 1 organization
I20250707000696 PA Practitioner - Physician Assistant 7911338058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

825 Old Lancaster Rd
Suite 250
Bryn Mawr, PA 19010-3239
Phone (484) 227-9700

830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118

Hospital & facility affiliations

  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153
  • Riddle Memorial Hospital Hospital, Media, PA, CCN 390222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA066467PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based CurrentSince Mar 1, 2020 Accepting new patients

Locations

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1962047290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336",
            "telephone_number": "484-337-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVENUE",
            "address_2": "SUITE 375 MEDICAL SCIENCE BUILDING",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963433",
            "telephone_number": "610-645-9093",
            "fax_number": "610-645-9476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 10th Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100191147",
            "country_code": "US",
            "telephone_number": "610-781-4682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERS",
        "first_name": "MAUREEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA066467",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024441",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.