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NPI Code Detail

MEDICARE: KATHERINE HALLOCK

MEDICARE: KATHERINE HALLOCK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianMD471467PA

General Provider Information

NPI Number : 1073977146
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE HALLOCK
Provider Business Mailing Address
First Line : 1516 LOCUST ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-4409
Country : US
Telephone Number : 215-545-5459
Fax Number :
Provider Business Practice Location Address
First Line : 1516 LOCUST ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-4409
Country : US
Telephone Number : 215-545-5459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2016
Last Update Date : 09/28/2023

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Directions to “ KATHERINE HALLOCK ” Practice Location

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