Provider Demographics
NPI:1265419162
Name:VANDERHEI, KATHRYN ELAINE (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELAINE
Last Name:VANDERHEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HENRY AVE
Mailing Address - Street 2:ONE FALLS CENTER
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1121
Mailing Address - Country:US
Mailing Address - Phone:215-842-7415
Mailing Address - Fax:215-848-1355
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:ONE FALLS CENTER
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:215-842-7415
Practice Address - Fax:215-848-1355
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD02559ZE208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5388055OtherAETNA PPO
PA001613928Medicaid
PA189872OtherHIGHMARK BLUE SHIELD
PA001613928Medicaid
PA5388055OtherAETNA PPO