Provider Demographics
NPI:1427554096
Name:FAY, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FAY
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 1:525 E. MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304
Mailing Address - Country:US
Mailing Address - Phone:330-375-3584
Mailing Address - Fax:330-375-3730
Practice Address - Street 1:55 ARCH ST STE 3A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1447
Practice Address - Country:US
Practice Address - Phone:330-375-3584
Practice Address - Fax:330-375-3730
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.141881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine