Provider Demographics
NPI:1124028667
Name:FACCINI, KATHRYN LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LORRAINE
Last Name:FACCINI
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 1:98 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2245
Mailing Address - Country:US
Mailing Address - Phone:330-759-9004
Mailing Address - Fax:
Practice Address - Street 1:98 ORIOLE DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2245
Practice Address - Country:US
Practice Address - Phone:330-759-9004
Practice Address - Fax:330-759-9005
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424718207RX0202X
OH35.078694207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF39623Medicare UPIN