Provider Demographics
NPI:1154912376
Name:TOMACK, ALLISON (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TOMACK
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 1:1338 CHESTNUT ST APT 610
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4505
Mailing Address - Country:US
Mailing Address - Phone:570-916-0417
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 170
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3234
Practice Address - Country:US
Practice Address - Phone:610-527-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant