Provider Demographics
NPI:1912120924
Name:DIXLER, TIKVA CHANA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIKVA
Middle Name:CHANA
Last Name:DIXLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 SMITH AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:410-580-0900
Mailing Address - Fax:410-580-0773
Practice Address - Street 1:2835 SMITH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1453
Practice Address - Country:US
Practice Address - Phone:410-580-0900
Practice Address - Fax:410-580-0773
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0002133OtherSTATE LIC
MDMD0673738OtherDEA
S86924Medicare UPIN
258FMedicare ID - Type UnspecifiedINDIVIDUAL
MDC0002133OtherSTATE LIC