Provider Demographics
NPI:1114970670
Name:PEDITTO, KATHLEEN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:PEDITTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:3251 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2022
Practice Address - Country:US
Practice Address - Phone:727-799-6385
Practice Address - Fax:813-635-7863
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110221224OtherRAILROAD MEDICARE NUMBER
FL251779500Medicaid
FL251779500Medicaid
FL18868XMedicare PIN