Provider Demographics
NPI:1881856466
Name:KAZATSKY, ASHLEY MARIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:MARIEL
Last Name:KAZATSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:MARIEL
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 PENN SQUARE EAST
Mailing Address - Street 2:9TH FLOOR NORTH TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-425-9200
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3500 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-1000
Practice Address - Fax:215-590-2180
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0155252080P0201X
PAOT012551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026075340003Medicaid