MEDICARE: KATHRYN ANNE BIELAWA

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
1	363A00000X	Physician Assistant	034763	NY

General Provider Information

NPI Number	:	1093552507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANNE BIELAWA

Provider Business Mailing Address
First Line	:	600 S 43RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 NEW SCOTLAND AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3403
Country	:	US
Telephone Number	:	518-262-0941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	02/10/2026

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