Provider Demographics
NPI:1104261502
Name:PEHLIVAN, KATHERINE CLARK (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CLARK
Last Name:PEHLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40 SUNSHINE COTTAGE RD # 1N-H15
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1524
Mailing Address - Country:US
Mailing Address - Phone:914-594-2131
Mailing Address - Fax:
Practice Address - Street 1:40 SUNSHINE COTTAGE RD # 1N-H15
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1524
Practice Address - Country:US
Practice Address - Phone:914-594-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1624432080P0207X
NY307117-012080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology