Healthcare Provider Details

I. General information

NPI: 1033228184
Provider Name (Legal Business Name): JAMES J KOLENICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 EDGEWOOD DRIVE EXT.
TRANSFER PA
16154-9999
US

IV. Provider business mailing address

239 EDGEWOOD DRIVE EXT.
TRANSFER PA
16154-9999
US

V. Phone/Fax

Practice location:
  • Phone: 724-646-0400
  • Fax: 724-646-0413
Mailing address:
  • Phone: 724-646-0400
  • Fax: 724-646-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD016698E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: