Provider Demographics
NPI:1154382364
Name:PATRICK, KATHLEEN E (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
Last Name:PATRICK
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 1:829 SPRUCE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-627-5272
Mailing Address - Fax:215-627-7466
Practice Address - Street 1:829 SPRUCE ST
Practice Address - Street 2:STE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-627-5272
Practice Address - Fax:215-627-7466
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029970E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B37811Medicare UPIN
PA132530Medicare ID - Type Unspecified