MEDICARE: SANDRA KOFFLER PHD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PS002520L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285679514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA KOFFLER PHD.

Provider Business Mailing Address
First Line	:	1518 WALNUT ST
Second Line	:	SUITE 607
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3419
Country	:	US
Telephone Number	:	267-416-0506
Fax Number	:	215-545-2442

Provider Business Practice Location Address
First Line	:	1518 WALNUT ST
Second Line	:	SUITE 607
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3419
Country	:	US
Telephone Number	:	267-416-0506
Fax Number	:	215-545-2442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	03/07/2017

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Directions to “ SANDRA KOFFLER PHD.” Practice Location

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