1508049909 NPI number — MRS. KATHLEEN CARILLA CRNA

Table of content: MRS. KATHLEEN CARILLA CRNA (NPI 1508049909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508049909 NPI number — MRS. KATHLEEN CARILLA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARILLA
Provider First Name:
KATHLEEN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PALMATORY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508049909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNITED ANESTHESIA SERVICES
Provider Second Line Business Mailing Address:
610 W. GERMANTOWN PIKE SUITE 150
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-525-4966
Provider Business Mailing Address Fax Number:
610-525-0874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RIDDLE MEMORIAL HOSPITAL
Provider Second Line Business Practice Location Address:
1068 W. BALTIMORE PIKE
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-227-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2007

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: 367500000X , with the licence number:  RN278989L , 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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