MS. TAEJA BROADWATER (NPI# 1114152329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114152329 |
| Entity Type | Individual |
| Full Name | MS. TAEJA BROADWATER |
| Credential | PA-C |
| Practice Address |
Geisinger Medical Ctr 100 North Academy Drive Danville PA 17822-0001 |
| Mailing Address |
1015 Clifton Dr Bloomsburg PA 17815-3083 |
| Practice Telephone | 5702715555 |
| Mailing Telephone | 3046739476 |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2013-09-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WM0705X |
Registered Nurse Specialization: Medical-Surgical |
R185137 | MD | Nursing Service Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
MAO55689 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
GEISINGER MEDICAL CTR 100 NORTH ACADEMY DRIVE |
| City | DANVILLE |
| State | PA |
| Zip Code | 17822-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952389082 | Christopher Coppola | Surgery | Geisinger Medical Ctr, 100 N. Academy Av. Mc 21-70, Danville, PA 17822-2170 | 2006-01-09 |
| 1508392093 | Cassandra Anne Ricketts | Orthopaedic Surgery | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-05-03 |
| 1841726593 | Theodore James | Student in an Organized Health Care Education/Training Program | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-05-01 |
| 1972038677 | Craig Dix | Emergency Medicine | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-05-01 |
| 1275068884 | Sasha Gorrell | Student in an Organized Health Care Education/Training Program | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-04-21 |
| 1669906533 | Satabdi Chakrabarti Hudson | Student in an Organized Health Care Education/Training Program | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-04-17 |
| 1265965883 | Johnny Minh Phan | Psychiatry & Neurology | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-04-10 |
| 1316470743 | Madhuri Uppalapati | Student in an Organized Health Care Education/Training Program | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-04-04 |
| 1376074344 | Maria Elena Golden | Psychologist | Geisinger Medical Ctr, 100 N. Academy Ave., Danville, PA 17822 | 2017-03-22 |
| 1568903912 | Harleen Sodhi | Student in an Organized Health Care Education/Training Program | Geisinger Medical Ctr, 100 North Academy Avenue, Danville, PA 17822-0001 | 2017-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366062895 | Staci Lee Benoit | Student in an Organized Health Care Education/Training Program | 100 North Academy Avenue Geisinger Medical Center, Danville, PA 17822 | 2020-04-24 |
| 1275162018 | Kristena Yossef | Student in an Organized Health Care Education/Training Program | Geisinger Medical Center, 100 North Academy Avenue, Da, Danville, PA 17822 | 2020-04-03 |
| 1003470444 | Intekhab Askari Syed Ahmad Raza | Student in an Organized Health Care Education/Training Program | 100 North Academy Avenue, Geisinger Medical Center, Danville, PA 17822 | 2019-04-30 |
| 1841766334 | Sarah Louise Dearment | Counselor | Geisinger Medical Center: Department of Psychiatry, 100 N. Academy Avenue, Danville, PA 17822 | 2018-10-23 |
| 1548753908 | Josie Pervola | Genetic Counselor, MS | 100 N Academy Ave Mc-26-20, Danville, PA 17822 | 2018-06-11 |
| 1477059350 | Martha Niemiec | Counselor | Geisinger Medical Center Department of Psychiatry, 100 North Academy Avenue, Danville, PA 17822 | 2018-04-01 |
| 1730625450 | Nir Shimony | Neurological Surgery | 100 N. Academy Ave., Geisinger Medical Center, Neurosurgery Department, Danville, PA 17822 | 2017-01-19 |
| 1164877197 | Britta Hunter | Speech-Language Pathologist | 100 N. Academy Ave., Danville, PA 17822 | 2016-04-27 |
| 1891180725 | Zach Rottmann | Internal Medicine | Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822 | 2015-03-30 |
| 1891063251 | John D Chakan | Pharmacist | 1000 S Second St, Sunbury, PA 17822 | 2011-12-13 |
| Find all providers in zip 17822 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629589981 | Bryce Alden Petersheim | Physician Assistant | 100 N Academy Ave, Danville, PA 17822-9800 | 2017-10-13 |
| 1780076919 | Lauren B. Peters | Physician Assistant | 115 Woodbine Ln, Danville, PA 17822-5212 | 2015-02-25 |
| 1295921732 | Heather D Letcavage | Physician Assistant | 115 Woodbine Ln, Danville, PA 17821-9118 | 2007-09-19 |
| 1699737585 | Wayne Thomas Wing | Physician Assistant | 1900 E Main St, Surgical Service, Danville, IL 61832-5100 | 2006-04-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450087 | Mary Baich | Physician Assistant | 1050 Bower Hill Rd Ste 208, Pittsburgh, PA 15243-1868 | 2020-06-08 |
| 1972145134 | Emilie A Simone | Physician Assistant | 1050 Bower Hill Rd Ste 309, Pittsburgh, PA 15243-1870 | 2019-10-09 |
| 1518524339 | Nicholas Vernoy Smith | Physician Assistant | 510 South Aiken Avenue, Suite Eg-01 East Wing Shadyside Hospital, Pittsburgh, PA 15232-1505 | 2019-05-28 |
| 1689131757 | Amanda Furst | Physician Assistant | 9100 Babcock Blvd Ste 4828, Pittsburgh, PA 15237-5815 | 2019-02-26 |
| 1659845295 | Alexis Kimes | Physician Assistant | 200 Lothrop St Fl 4, Pittsburgh, PA 15213-2536 | 2019-01-16 |
| 1427530831 | Jordan L Ball | Physician Assistant | 30 Hope Dr # 1200, Hershey, PA 17033-2036 | 2018-08-31 |
| 1740707298 | Robyn Mcnamee | Physician Assistant | 142 Clearview Cir Ste 110, Butler, PA 16001-1565 | 2017-08-25 |
| 1831648336 | Hollie Anne Ramaley | Physician Assistant | 624 E End Ave, Pittsburgh, PA 15221-3424 | 2016-09-25 |
| 1083169890 | Ellen Cannon | Physician Assistant | 1023 Marlin Dr, West Chester, PA 19382-2360 | 2016-08-22 |
| 1295182491 | Emily Tercek | Physician Assistant | 620 Howard Ave Fl 7, Altoona, PA 16601-4804 | 2016-05-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MS. TAEJA BROADWATER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.