Provider Demographics
NPI:1790710788
Name:LEARY, KATHLEEN E (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:LEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1600 HORIZON DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-4100
Mailing Address - Country:US
Mailing Address - Phone:215-997-9737
Mailing Address - Fax:215-997-9738
Practice Address - Street 1:1600 HORIZON DR
Practice Address - Street 2:SUITE 117
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914
Practice Address - Country:US
Practice Address - Phone:215-997-9737
Practice Address - Fax:215-997-9738
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD423185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078807Medicare PIN
I05926Medicare UPIN