Healthcare Provider Details

I. General information

NPI: 1801435714
Provider Name (Legal Business Name): KATHRYN ANN UNGUREAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 STATE HILL RD STE 5
WYOMISSING PA
19610-1993
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-2490
  • Fax:
Mailing address:
  • Phone: 717-270-7688
  • Fax: 717-270-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061365
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberOA005168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: