Provider Demographics
NPI:1457603474
Name:NASSAR, KATHRYN E (PA-L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:NASSAR
Suffix:
Gender:F
Credentials:PA-L
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:E
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 CETRONIA RD STE 205N
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9263
Mailing Address - Country:US
Mailing Address - Phone:484-426-2600
Mailing Address - Fax:833-816-7512
Practice Address - Street 1:240 CETRONIA RD STE 205N
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9263
Practice Address - Country:US
Practice Address - Phone:484-426-2600
Practice Address - Fax:833-816-7512
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004036363A00000X
PA0A003217363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant