Provider Demographics
NPI:1699095778
Name:KOLB, KENDRA RUTH (MD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:RUTH
Last Name:KOLB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:RUTH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-6700
Practice Address - Fax:610-402-6744
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196948208000000X
PAMD4494032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics