Provider Demographics
NPI:1770938862
Name:FLACK, KATHRYN FRIEDMAN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FRIEDMAN
Last Name:FLACK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:BLAIR
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:HARRON LUNG CENTER - PERELMAN CTR -1 WEST PAVILION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5138
Mailing Address - Country:US
Mailing Address - Phone:215-662-3202
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:3 RAVDIN BLDG. STE. F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-3202
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464744207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine