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Kelly Lauren Cederquist

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3400 Spruce St, Philadelphia, PA 19104-4206

PECOS Enrollment

This provider is enrolled in PECOS as KELLY CEDERQUIST.

Based on the most recent information from CMS, provider Kelly Lauren Cederquist is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1669815965
Provider Type
Individual
Full Name
Cederquist, Kelly Lauren
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
4/17/2013
Last Updated
5/7/2013

Contact Information

Practice Location

3400 Spruce St, Philadelphia, PA 19104-4206

(215) 662-6200

Unlisted Fax

Mailing Location

3400 Spruce St, Transplant Surgery, Philadelphia, PA 19104-4206

(215) 662-6200

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License MA056112 Pennsylvania

Kelly Lauren Cederquist

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Fareri, Maria

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Brunker, Tamara M

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Shah, Jaimin J