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General NPI Number Information
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NPI Number | 1881558815
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Entity Type | Individual
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Provider Name | CAESAR BANKOLE PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 3500 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4106
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Country | US
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Telephone | 215-707-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 N 2ND ST UNIT 2H
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1870
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Country | US
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Telephone | 443-616-1953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA067414
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License Number State | PA
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