Provider Demographics
NPI:1376806687
Name:WIEFERICH, KATHRYN J (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:WIEFERICH
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 1:5030 CENTRE AVE APT 753
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1943
Mailing Address - Country:US
Mailing Address - Phone:740-516-5332
Mailing Address - Fax:
Practice Address - Street 1:230 MCKEE PL
Practice Address - Street 2:SUITE 500
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3903
Practice Address - Country:US
Practice Address - Phone:412-647-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT201285207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine