Provider Demographics
NPI:1093065849
Name:CANFIELD, KATHLEEN M (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 INDUSTRIAL BLVD., STE 204
Mailing Address - Street 2:PAOLI POINTE MED. OFFICE BLDG
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1620
Mailing Address - Country:US
Mailing Address - Phone:610-644-6251
Mailing Address - Fax:610-644-1440
Practice Address - Street 1:11 INDUSTRIAL BLVD., STE 204
Practice Address - Street 2:PAOLI POINTE MED. OFFICE BLDG
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-644-6251
Practice Address - Fax:610-644-1440
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055741363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical