Basic Information
| Provider Information | |||||||||
| NPI: | 1477525434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITCH | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1029 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163231242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144377266 | ||||||||
| FaxNumber: | 8144377148 | ||||||||
| Practice Location | |||||||||
| Address1: | 1029 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163231242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144377266 | ||||||||
| FaxNumber: | 8144377148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 03/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD070461L | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0017984010002 | 05 | PA | MEDICAID |