Healthcare Provider Details

I. General information

NPI: 1245075399
Provider Name (Legal Business Name): MARIA IOSHPA PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S SCHELL ST
PHILADELPHIA PA
19147-3923
US

IV. Provider business mailing address

903 S SCHELL ST
PHILADELPHIA PA
19147-3923
US

V. Phone/Fax

Practice location:
  • Phone: 917-882-5583
  • Fax:
Mailing address:
  • Phone: 917-882-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: