Healthcare Provider Details

I. General information

NPI: 1962495424
Provider Name (Legal Business Name): PHILLIP JOHN KURELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PHILLIP JOHN KURELLO MD

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 MOUNTAIN VIEW DR
LEHMAN PA
18627-0903
US

IV. Provider business mailing address

PO BOX C 1051 MOUNTAINVIEW DRIVE
LEHMAN PA
18627-0903
US

V. Phone/Fax

Practice location:
  • Phone: 570-675-4545
  • Fax: 570-675-7123
Mailing address:
  • Phone: 570-675-4545
  • Fax: 570-675-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039685L
License Number StatePA

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: