Provider Demographics
NPI:1366417305
Name:ENGLE, KRISTEN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LYNN
Last Name:ENGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:ENGLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 CARNEGIE PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15208-2705
Mailing Address - Country:US
Mailing Address - Phone:412-694-3271
Mailing Address - Fax:878-302-0303
Practice Address - Street 1:205 CARNEGIE PL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15208-2705
Practice Address - Country:US
Practice Address - Phone:412-694-3271
Practice Address - Fax:878-302-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63613208600000X
CAG76696208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G766960Medicaid
CAG54024Medicare UPIN
CA00G766962Medicare ID - Type Unspecified