MEDICARE: DR. KATHLEEN E. SQUIRES M.D.

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	207R00000X	Internal Medicine Physician	MD029556E	PA
2	207RI0200X	Infectious Disease Physician	MD029556E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659392926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN E. SQUIRES M.D.

Provider Business Mailing Address
First Line	:	1015 CHESTNUT ST
Second Line	:	SUITE 1020
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4310
Country	:	US
Telephone Number	:	215-955-7785
Fax Number	:	215-955-9362

Provider Business Practice Location Address
First Line	:	1015 CHESTNUT ST
Second Line	:	SUITE 1020
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4310
Country	:	US
Telephone Number	:	215-955-7785
Fax Number	:	215-955-9362

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/10/2015

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Directions to “ DR. KATHLEEN E. SQUIRES M.D.” Practice Location

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