Basic Information
| Provider Information | |||||||||
| NPI: | 1548851694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOGLER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ALICIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 RUSH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW EAGLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150671231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248845062 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1307 FEDERAL ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123594644 | ||||||||
| FaxNumber: | 4123592335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2021 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA062116 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.