Provider Demographics
NPI:1841306230
Name:BROBST, ALLISON L (PAC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:BROBST
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N 17TH STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5014
Mailing Address - Country:US
Mailing Address - Phone:610-820-3900
Mailing Address - Fax:610-820-3835
Practice Address - Street 1:401 N 17TH STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5014
Practice Address - Country:US
Practice Address - Phone:610-820-3900
Practice Address - Fax:610-820-3835
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
095455G6XMedicare ID - Type Unspecified
Q0028Medicare UPIN