Healthcare Provider Details

I. General information

NPI: 1013980887
Provider Name (Legal Business Name): KATHIE ANN GARES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MARKET ST
PHILADELPHIA PA
19107-3721
US

IV. Provider business mailing address

6 STIRLING CT
CHESTERBROOK PA
19087-5703
US

V. Phone/Fax

Practice location:
  • Phone: 215-580-7128
  • Fax: 215-580-3726
Mailing address:
  • Phone: 610-296-9516
  • Fax: 215-580-3726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD021692-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: