Provider Demographics
NPI:1356693220
Name:COLABINE, JESSE TODD (PA-C)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:TODD
Last Name:COLABINE
Suffix:
Gender:M
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 1:5176 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17813-9268
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5176 CREEK RD
Practice Address - Street 2:
Practice Address - City:BEAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:17813-9268
Practice Address - Country:US
Practice Address - Phone:570-898-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical