Provider Demographics
NPI:1730513193
Name:PONZIO, CHRISTINA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:PONZIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:GUARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:822 PINE STREET
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-519-0154
Mailing Address - Fax:267-516-0597
Practice Address - Street 1:100 BRICK RD STE 306
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:565-960-1111
Practice Address - Fax:856-596-7194
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant