Provider Demographics
NPI:1548851694
Name:KOGLER, JULIE ALICIA (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ALICIA
Last Name:KOGLER
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 1:127 RUSH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW EAGLE
Mailing Address - State:PA
Mailing Address - Zip Code:15067-1231
Mailing Address - Country:US
Mailing Address - Phone:724-884-5062
Mailing Address - Fax:
Practice Address - Street 1:1307 FEDERAL ST STE 301
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-4644
Practice Address - Fax:412-359-2335
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062116363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical