Provider Demographics
NPI:1932282738
Name:KANELLITSAS, IOANNA (MD)
Entity type:Individual
Prefix:DR
First Name:IOANNA
Middle Name:
Last Name:KANELLITSAS
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 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-371-6172
Mailing Address - Fax:814-371-3921
Practice Address - Street 1:433 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1690
Practice Address - Country:US
Practice Address - Phone:419-633-0755
Practice Address - Fax:419-633-0758
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0028672207V00000X
PAMD451406207V00000X
OH35.077266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA353894OtherMEDICARE PTAN- INDIVIDUAL
PA102920926Medicaid
OH2205741Medicaid