Provider Demographics
NPI:1336188465
Name:BOELLNER-KAHN, ALICIA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANNE
Last Name:BOELLNER-KAHN
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 1:3031 WALTON RD
Mailing Address - Street 2:C101
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2369
Mailing Address - Country:US
Mailing Address - Phone:610-825-3500
Mailing Address - Fax:610-825-8502
Practice Address - Street 1:3031 WALTON RD
Practice Address - Street 2:C101
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2369
Practice Address - Country:US
Practice Address - Phone:610-825-3500
Practice Address - Fax:610-825-8502
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051015L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014630250004Medicaid
PA0014630250004Medicaid