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General NPI Number Information
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NPI Number | 1932463080
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Entity Type | Individual
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Provider Name | LAUREN KINNEMAN D.O
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Gender | Female
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 425-443-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 CHESTER AVE APT 110
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4464
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Country | US
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Telephone | 425-443-4414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0116025105
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | OS019304
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License Number State | PA
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