Provider Demographics
NPI:1376508382
Name:HOLLERAN, KATHLEEN E (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
Last Name:HOLLERAN
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 1:5375 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9666
Mailing Address - Country:US
Mailing Address - Phone:724-444-4700
Mailing Address - Fax:724-444-4730
Practice Address - Street 1:5375 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9666
Practice Address - Country:US
Practice Address - Phone:724-444-4700
Practice Address - Fax:724-444-4730
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014347410001Medicaid
OH2623049Medicaid
WV3810008660Medicaid
PA1014347410002Medicaid
PA095363NJKMedicare PIN
WV3810008660Medicaid
OH2623049Medicaid