MEDICARE: KATHRYN ELAINE VANDERHEI MD

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	208000000X	Pediatrics Physician	MD02559ZE	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5388055	OTHER	PA	AETNA PPO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	189872	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1265419162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ELAINE VANDERHEI MD

Provider Business Mailing Address
First Line	:	3300 HENRY AVE
Second Line	:	ONE FALLS CENTER
City	:	PHILA
State	:	PA
Zip	:	19129-1121
Country	:	US
Telephone Number	:	215-842-7415
Fax Number	:	215-848-1355

Provider Business Practice Location Address
First Line	:	3300 HENRY AVE
Second Line	:	ONE FALLS CENTER
City	:	PHILA
State	:	PA
Zip	:	19129-1121
Country	:	US
Telephone Number	:	215-842-7415
Fax Number	:	215-848-1355

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/26/2011

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