Provider Demographics
NPI:1689124620
Name:FISHPAW, CHARLES KROHN (PA-S)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KROHN
Last Name:FISHPAW
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 PINE ST
Mailing Address - Street 2:C10
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6745
Mailing Address - Country:US
Mailing Address - Phone:701-240-8119
Mailing Address - Fax:
Practice Address - Street 1:1616 PINE ST
Practice Address - Street 2:C10
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6745
Practice Address - Country:US
Practice Address - Phone:701-240-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program