Provider Demographics
NPI:1801456421
Name:POKRANT, CARISSA ANTONIA (DO)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:ANTONIA
Last Name:POKRANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CARISSA
Other - Middle Name:ANTONIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 MEMORIAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-1366
Mailing Address - Country:US
Mailing Address - Phone:724-528-2513
Mailing Address - Fax:724-528-8088
Practice Address - Street 1:SHENANGO VALLEY FAMILY MEDICINE
Practice Address - Street 2:2000 MEMORIAL DR, SUITE B
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121
Practice Address - Country:US
Practice Address - Phone:724-983-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS022184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program