Healthcare Provider Details
I. General information
NPI: 1184945990
Provider Name (Legal Business Name): KATHERINE JOANNE KERESHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/15/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
35 HOPE DR STE 102
HERSHEY PA
17033-2086
US
IV. Provider business mailing address
PO BOX 858 MC A410
HERSHEY PA
17033-0858
US
V. Phone/Fax
- Phone: 717-531-7300
- Fax: 717-531-3527
- Phone: 800-243-1455
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | LL32811 |
| License Number State | SC |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | MD457372 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: