Healthcare Provider Details

I. General information

NPI: 1467489344
Provider Name (Legal Business Name): KIMBERLY A KOLONICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E PARK AVE STE 201
STATE COLLEGE PA
16803-6706
US

IV. Provider business mailing address

96 KISH RD
REEDSVILLE PA
17084-8943
US

V. Phone/Fax

Practice location:
  • Phone: 844-278-4600
  • Fax: 814-231-7098
Mailing address:
  • Phone: 717-667-7720
  • Fax: 717-667-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD046362L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: