Provider Demographics
NPI:1265434781
Name:SELVAGGI, KATHY J (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:SELVAGGI
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:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-284-4060
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:129 ONEIDA VALLEY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2252
Practice Address - Country:US
Practice Address - Phone:724-968-5330
Practice Address - Fax:724-431-2951
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036967E2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100981047Medicaid
PAF18371Medicare UPIN
PA712368SDBMedicare PIN