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NPI Code Detail

MEDICARE: DR. KATHLEEN M DUDENHOEFER MD

MEDICARE: DR. KATHLEEN M DUDENHOEFER 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
1208000000XPediatrics PhysicianMD017617EPA

General Provider Information

NPI Number : 1760467336
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHLEEN M DUDENHOEFER MD
Provider Business Mailing Address
First Line : 1202 STATE ST
Second Line :
City : ERIE
State : PA
Zip : 16501-1914
Country : US
Telephone Number : 814-454-4530
Fax Number : 814-454-4530
Provider Business Practice Location Address
First Line : 1202 STATE ST
Second Line :
City : ERIE
State : PA
Zip : 16501-1914
Country : US
Telephone Number : 814-454-4530
Fax Number : 814-456-2375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 06/29/2012

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