Basic Information
| Provider Information | |||||||||
| NPI: | 1649431297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODD | ||||||||
| FirstName: | TASHA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1482 BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162623914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242973424 | ||||||||
| FaxNumber: | 7242975425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1482 BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162623914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242973424 | ||||||||
| FaxNumber: | 7242975425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA052916 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 12200530 | 01 | CAQH | OTHER |