Healthcare Provider Details

I. General information

NPI: 1306028220
Provider Name (Legal Business Name): KATIE ALISSA TOKARSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH STREET AND CIVIC CENTER BOULEVARD 1ST FLOOR WOOD BUILDING
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

309 BOYER RD
CHELTENHAM PA
19012-1903
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3440
  • Fax: 215-590-3986
Mailing address:
  • Phone: 267-882-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: