Provider Demographics
NPI:1043901754
Name:TOBIN, KATHERINE MARGARET
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARGARET
Last Name:TOBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST.
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507
Mailing Address - Country:US
Mailing Address - Phone:814-877-5330
Mailing Address - Fax:814-877-5331
Practice Address - Street 1:300 STATE STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-877-5330
Practice Address - Fax:814-877-5331
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant