Provider Demographics
NPI:1952639601
Name:KATHLEEN S. VEGLIA, M.D.
Entity Type:Organization
Organization Name:KATHLEEN S. VEGLIA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VEGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-454-5222
Mailing Address - Street 1:1525 N. CHURCH ST.
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202
Mailing Address - Country:US
Mailing Address - Phone:570-454-5222
Mailing Address - Fax:570-454-5967
Practice Address - Street 1:1525 N. CHURCT ST.
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-454-5222
Practice Address - Fax:570-454-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031654E207N00000X
PAMD427833207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011228860003Medicaid
PA0011228860003Medicaid