Provider Demographics
NPI:1053020479
Name:AMIGE, GABRIELLA TAL (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:TAL
Last Name:AMIGE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:817 N 3RD ST APT 401
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2564
Mailing Address - Country:US
Mailing Address - Phone:301-466-0485
Mailing Address - Fax:
Practice Address - Street 1:525 JAMESTOWN ST STE 205
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-750-0301
Practice Address - Fax:215-944-8971
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2025-05-14
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Provider Licenses
StateLicense IDTaxonomies
PAMA064173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant