Healthcare Provider Details

I. General information

NPI: 1851394423
Provider Name (Legal Business Name): KRISTIN FREDERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PACIFIC AVE
NATRONA HEIGHTS PA
15065-2138
US

IV. Provider business mailing address

103 BRADFORD RD STE 200
WEXFORD PA
15090-6910
US

V. Phone/Fax

Practice location:
  • Phone: 724-224-3900
  • Fax: 724-224-9010
Mailing address:
  • Phone: 724-933-1100
  • Fax: 724-933-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD051557L
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: