Healthcare Provider Details

I. General information

NPI: 1508316183
Provider Name (Legal Business Name): KATHLEEN ANN GMEINER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN GRIFFIN PA-C

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 WATER ST
THURMONT MD
21788-1912
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 301-271-3535
  • Fax: 301-271-2650
Mailing address:
  • Phone: 301-271-3535
  • Fax: 301-271-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA058545
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA003931
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC08741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: