Basic Information
| Provider Information | |||||||||
| NPI: | 1497738496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILKENNY | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL ROAD | ||||||||
| Address2: | ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129242548 | ||||||||
| FaxNumber: | 4122328215 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 BOWER HILL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125726194 | ||||||||
| FaxNumber: | 4125726195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | MD072425 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 174400000X | MD072425 | PA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 56-2589074 | 01 | PA | DEVON | OTHER | 5547135 | 01 | PA | CIGNA | OTHER | 56-2589074 | 01 | PA | INTERGROUP | OTHER | 0019120600005 | 05 | PA | MEDICAID | 1411895 | 01 | PA | HIGHMARK | OTHER | 0019120600001 | 05 | PA | MEDICAID | 317410 | 01 | PA | UPMC | OTHER | 56-2589074 | 01 | PA | HEALTH AMERICA | OTHER | 56-2589074 | 01 | PA | UNITED HEALTHCARE | OTHER |