Provider Demographics
NPI:1356349849
Name:NEELY, KATHERINE PATTERSON (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:PATTERSON
Last Name:NEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:LOUISE PATTERSON
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4044 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-7808
Mailing Address - Country:US
Mailing Address - Phone:724-527-6651
Mailing Address - Fax:724-527-0957
Practice Address - Street 1:4044 ROUTE 130
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-7808
Practice Address - Country:US
Practice Address - Phone:724-527-6651
Practice Address - Fax:724-527-0957
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050545L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10933903OtherCAQH
PA001547887Medicaid
PAF90420Medicare UPIN