Provider Demographics
NPI:1881558815
Name:BANKOLE, CAESAR (PA-C)
Entity type:Individual
Prefix:
First Name:CAESAR
Middle Name:
Last Name:BANKOLE
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 1:1148 N 2ND ST UNIT 2H
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1870
Mailing Address - Country:US
Mailing Address - Phone:443-616-1953
Mailing Address - Fax:
Practice Address - Street 1:3500 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4106
Practice Address - Country:US
Practice Address - Phone:215-707-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-13
Last Update Date:2025-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA067414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant