Provider Demographics
NPI:1114147147
Name:BREIT, KATHRYN R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:R
Last Name:BREIT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 PARMALEE AVE
Mailing Address - Street 2:STE 510
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1716
Mailing Address - Country:US
Mailing Address - Phone:330-744-2118
Mailing Address - Fax:330-744-2110
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:STE 510
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-744-2118
Practice Address - Fax:330-744-2110
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002360363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091750Medicaid
OH0091750Medicaid