Provider Demographics
NPI:1023048568
Name:SYDNOR, KATHERINE (DPM)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:SYDNOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1704
Mailing Address - Country:US
Mailing Address - Phone:610-444-6520
Mailing Address - Fax:610-444-2232
Practice Address - Street 1:692 UNIONVILLE RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-444-6520
Practice Address - Fax:610-444-2232
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000092213E00000X
PASC003303L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000227517Medicaid
PA001211467Medicaid
DE520527F28Medicare PIN
T73035Medicare UPIN