Healthcare Provider Details

I. General information

NPI: 1972990893
Provider Name (Legal Business Name): KELLEY WEINFURTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 3 DULLES BUILDING
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 3 DULLES BUILDING
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8222
  • Fax: 215-349-5915
Mailing address:
  • Phone: 215-349-8222
  • Fax: 215-349-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD478369
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberMD478369
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD478369
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: