Provider Demographics
NPI:1619799541
Name:FORTE, MIA GENERA (PA-C)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:GENERA
Last Name:FORTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8096 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-2714
Mailing Address - Country:US
Mailing Address - Phone:610-554-6013
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-6510
Practice Address - Fax:302-733-3340
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0012201363A00000X
PAMA066138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant