Provider Demographics
NPI:1811955677
Name:DANIELE, KATHLEEN B (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:DANIELE
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 1:2000 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3776
Mailing Address - Country:US
Mailing Address - Phone:724-834-6900
Mailing Address - Fax:724-834-2896
Practice Address - Street 1:2000 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3776
Practice Address - Country:US
Practice Address - Phone:724-834-6900
Practice Address - Fax:724-834-2896
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009257810007Medicaid
G80307Medicare UPIN
077844Medicare ID - Type Unspecified
PA1009257810007Medicaid