1063474732 NPI number — DR. KAREN DURST KIELY PH.D.

Table of content: DR. KAREN DURST KIELY PH.D. (NPI 1063474732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063474732 NPI number — DR. KAREN DURST KIELY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIELY
Provider First Name:
KAREN
Provider Middle Name:
DURST
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063474732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 LE ROI RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15208-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-241-2184
Provider Business Mailing Address Fax Number:
412-241-6769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5889 FORBES AVE
Provider Second Line Business Practice Location Address:
SUITE 320, FORBES/SHADY COMMONS
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15217-1660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-421-7155
Provider Business Practice Location Address Fax Number:
412-241-6769
Provider Enumeration Date:
04/06/2006

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: 103TC0700X , with the licence number:  PS004591L , 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)

  • Identifier: 058120 . This is a "PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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