1356349849 NPI number — DR. KATHERINE PATTERSON NEELY MD

Table of content: DR. KATHERINE PATTERSON NEELY MD (NPI 1356349849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356349849 NPI number — DR. KATHERINE PATTERSON NEELY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEELY
Provider First Name:
KATHERINE
Provider Middle Name:
PATTERSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEELY
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
LOUISE PATTERSON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356349849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4044 ROUTE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRWIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15642-7808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-6651
Provider Business Mailing Address Fax Number:
724-527-0957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4044 ROUTE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRWIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-527-6651
Provider Business Practice Location Address Fax Number:
724-527-0957
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD050545L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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