Provider Demographics
NPI:1346294709
Name:SWEENEY, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:SUITE F2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE F2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-889-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005741L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA203247OtherUPMC HEALTH PLAN
PA1427OtherGEISINGER HEALTH PLAN
PA1546799OtherGATEWAY HEALTH PLAN OB
PAP000242OtherGATEWAY HEALTH PLAN
PA0011115790002Medicaid
PA74017OtherUNISON HEALTH PLAN
PA423087OtherHIGHMARK BC/BS
423087Medicare ID - Type UnspecifiedMEDICARE PART B
PA203247OtherUPMC HEALTH PLAN