=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255699369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN MICHAEL BARTOLOMUCCI D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2012
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 VILLAGE DR
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-3787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-420-5928
-----------------------------------------------------
Fax | 724-219-3120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 VILLAGE DR
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-3787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-420-5928
-----------------------------------------------------
Fax | 724-219-3120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS016713
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------