MEDICARE: KATHRYN LORRAINE DEARING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	01054163A	IN
2	2080A0000X	Pediatric Adolescent Medicine Physician	35090470	OH

General Provider Information

NPI Number	:	1649365032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN LORRAINE DEARING M.D.

Provider Business Mailing Address
First Line	:	3155 RUNNING DEER TRAIL
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005
Country	:	US
Telephone Number	:	937-760-5903
Fax Number	:	937-667-8067

Provider Business Practice Location Address
First Line	:	1483 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	937-667-7711
Fax Number	:	937-667-8067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/16/2017

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