Provider Demographics
NPI:1154546398
Name:TRAYES, KATHRYN POOL (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:POOL
Last Name:TRAYES
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 1:2130 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3502
Mailing Address - Country:US
Mailing Address - Phone:215-955-9555
Mailing Address - Fax:215-988-0545
Practice Address - Street 1:JEFFERSON HEALTH - ART MUSEUM
Practice Address - Street 2:2130 SPRING GARDEN STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-955-9555
Practice Address - Fax:215-988-0545
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188353207Q00000X
PAMD436271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023701010001Medicaid
NJ0206792Medicaid
PAMT188353OtherMEDICAL TRAINING LISCENSE
PA1023701010002Medicaid
PA164670Medicare PIN