Provider Demographics
NPI:1396753331
Name:ABBRUZZI, KRISTIN (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ABBRUZZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1165
Mailing Address - Country:US
Mailing Address - Phone:610-867-4151
Mailing Address - Fax:610-867-9129
Practice Address - Street 1:685 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1165
Practice Address - Country:US
Practice Address - Phone:610-867-4151
Practice Address - Fax:610-867-9129
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008811L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
028617Medicare ID - Type Unspecified
G97646Medicare UPIN