Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Miss. Mia Deritis

Individual provider Medical Physician Assistant · NPI 1073063012

Miss. Mia Deritis is a Physician Assistant in Pennington, New Jersey. Qualified in 2018, 8 years ago. Practices with Cmc Department of Medicine Group PA, a 474-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
8
Licensed in
NJ
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

1 Capital Way
Pennington, NJ 08534-2520
Phone: (800) 637-2374
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1925 Pacific Ave, Atlantic City, NJ 08401-6713 — (609) 449-4373
  • 2 Capital Way Ste 456, Pennington, NJ 08534-2521 — (609) 537-7300

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 25MP00518400 (NJ)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 25MP00518400 (NJ)

Record details

NPI number1073063012
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 13, 2016
Last updated in NPPESDecember 9, 2024
Certification dateDecember 9, 2024
Mailing address1 Capital Way, Pennington, NJ 08534-2520

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Cmc Department Of Medicine Group Pa — 474 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Pennington