Provider Demographics
NPI:1255502902
Name:SKABLA, PATSY L (PA-C)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:L
Last Name:SKABLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3449
Mailing Address - Country:US
Mailing Address - Phone:610-527-1600
Mailing Address - Fax:610-527-9369
Practice Address - Street 1:100 E LANCASTER AVE STE 222
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-527-1600
Practice Address - Fax:610-527-9369
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057566363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH114730Medicare PIN
OH0069255Medicaid