Provider Demographics
NPI:1235188202
Name:JOLLEY, KARA GASINK (MD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:GASINK
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:TOWNSEND
Other - Last Name:GASINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:6TH FLOOR WANAMAKER BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:215-590-6267
Mailing Address - Fax:
Practice Address - Street 1:500 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2219
Practice Address - Country:US
Practice Address - Phone:215-590-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2110369Medicaid
MAA39342Medicare ID - Type Unspecified
MA2110369Medicaid