Healthcare Provider Details

I. General information

NPI: 1932282738
Provider Name (Legal Business Name): IOANNA KANELLITSAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W HIGH ST
BRYAN OH
43506-1690
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 419-633-0755
  • Fax: 419-633-0758
Mailing address:
  • Phone: 814-371-6172
  • Fax: 814-371-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0028672
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD451406
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.077266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: