Provider Demographics
NPI:1760910780
Name:PALLEGEDARA, KATHRYN MARISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARISSA
Last Name:PALLEGEDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARISSA
Other - Last Name:PAOLUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 CIVIC CENTER BOULEVARD
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA, 9NW ROOM 55
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-1220
Mailing Address - Fax:
Practice Address - Street 1:5003 UMBRIA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4369
Practice Address - Country:US
Practice Address - Phone:215-483-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT212738208000000X
PAMD470136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics