Most Relevant Information
Provider Data
| NPI Number: | 1003387572 |
| Provider Name: | CARISSA SUSAN MCILWAIN PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 207V00000X |
| Specialty: | Obstetrics & Gynecology |
| License Number: | OA002318 |
Most Important Dates
| Enumeration Date: | 12/10/2018 |
| Last Updated: | 12/10/2018 |
Provider Practice Location
25 BALA AVE STE 205
BALA CYNWYD
PA
190043215
Practice Location Phone/Fax
| Phone: | 6106676363 |
| Fax: |
Provider Mailing Location
19 OLD OAKS RD
BRYN MAWR
PA
190101024
Provider Mailing Phone/Fax
| Phone: | 6105645739 |
| Fax: |
Suggested EMR
OBGYN EMR