Provider Demographics
NPI:1447608427
Name:MINERLY, KATHLEEN (DO,)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MINERLY
Suffix:
Gender:F
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-1306
Mailing Address - Country:US
Mailing Address - Phone:607-759-7979
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-208-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019616207Q00000X
PAOT016939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine