Healthcare Provider Details

I. General information

NPI: 1154393544
Provider Name (Legal Business Name): COLONIAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 EKASTOWN RD
SARVER PA
16055-9724
US

IV. Provider business mailing address

706 EKASTOWN RD
SARVER PA
16055-9724
US

V. Phone/Fax

Practice location:
  • Phone: 724-353-1508
  • Fax: 724-353-2040
Mailing address:
  • Phone: 724-353-1508
  • Fax: 724-353-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberOS003532L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberOS008948L
License Number StatePA

VIII. Authorized Official

Name: MRS. KATHERINE L. KRONEBERG
Title or Position: RECEPTIONIST
Credential:
Phone: 724-353-1508