Provider Demographics
NPI:1093786774
Name:PADGITT, KATHLEEN S (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:PADGITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BELMONT AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1125
Mailing Address - Country:US
Mailing Address - Phone:330-746-1488
Mailing Address - Fax:330-746-5611
Practice Address - Street 1:1340 BELMONT AVENUE
Practice Address - Street 2:SUITE 2300
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1191
Practice Address - Country:US
Practice Address - Phone:330-746-1488
Practice Address - Fax:330-746-5611
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060428P207RN0300X
PAMD050037L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1534074Medicaid
OH0917762Medicaid
OH0917762Medicaid
E84225Medicare UPIN
PA036521KOSMedicare ID - Type Unspecified