Provider Demographics
NPI:1205824075
Name:CASE, VICTORIA D (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:D
Last Name:CASE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:D
Other - Last Name:GREGORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2121 OLD GATESBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2290
Mailing Address - Country:US
Mailing Address - Phone:814-231-6868
Mailing Address - Fax:814-231-1581
Practice Address - Street 1:2121 OLD GATESBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2290
Practice Address - Country:US
Practice Address - Phone:814-231-6868
Practice Address - Fax:814-231-1581
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002123-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant