Provider Demographics
NPI:1457415390
Name:OMALLEY, KATHRYN ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELLEN
Last Name:OMALLEY
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 1:608 READING RD STE D
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1561
Mailing Address - Country:US
Mailing Address - Phone:513-398-3900
Mailing Address - Fax:513-398-4950
Practice Address - Street 1:608 READING RD STE D
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1561
Practice Address - Country:US
Practice Address - Phone:513-398-3900
Practice Address - Fax:513-398-4950
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-052080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics