Provider Demographics
NPI:1255699369
Name:BARTOLOMUCCI, KEVIN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:BARTOLOMUCCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3787
Mailing Address - Country:US
Mailing Address - Phone:724-420-5928
Mailing Address - Fax:724-219-3120
Practice Address - Street 1:120 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3787
Practice Address - Country:US
Practice Address - Phone:724-420-5928
Practice Address - Fax:724-219-3120
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030143990001Medicaid
PA413875Medicare PIN