Healthcare Provider Details

I. General information

NPI: 1265128409
Provider Name (Legal Business Name): KAITLIN TAYLOR MCCANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN TAYLOR KELLY

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WELSH RD STE 101
HUNTINGDON VALLEY PA
19006-6357
US

IV. Provider business mailing address

49 N RIDGE AVE FL 1
AMBLER PA
19002-4519
US

V. Phone/Fax

Practice location:
  • Phone: 215-939-4251
  • Fax:
Mailing address:
  • Phone: 215-526-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA064474
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: