Healthcare Provider Details

I. General information

NPI: 1689997082
Provider Name (Legal Business Name): ANN FOLK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

1500 MARKET ST. LM 500 WEST TOWER
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-5030
  • Fax: 215-707-3494
Mailing address:
  • Phone: 215-985-2595
  • Fax: 267-762-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA003139L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: