Healthcare Provider Details

I. General information

NPI: 1376138974
Provider Name (Legal Business Name): BRIAN LEE KERN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE FL 4
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

110 NEWKIRK DR
GLENSHAW PA
15116-1210
US

V. Phone/Fax

Practice location:
  • Phone: 412-508-2842
  • Fax: 412-322-2144
Mailing address:
  • Phone: 910-286-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062019
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: