Provider Demographics
NPI:1710984349
Name:TIGUE, KATHLEEN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:TIGUE
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 1:920 VIEWMONT DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1664
Mailing Address - Country:US
Mailing Address - Phone:570-346-1464
Mailing Address - Fax:570-558-9051
Practice Address - Street 1:920 VIEWMONT DR
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1664
Practice Address - Country:US
Practice Address - Phone:570-346-1464
Practice Address - Fax:570-558-9051
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-072131-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018147570001Medicaid
PA0018147570001Medicaid