Provider Demographics
NPI:1811976327
Name:DAVE, KAILAS D (MD FAAP)
Entity type:Individual
Prefix:DR
First Name:KAILAS
Middle Name:D
Last Name:DAVE
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
Other - First Name:KAILAS
Other - Middle Name:R
Other - Last Name:DAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0603
Mailing Address - Country:US
Mailing Address - Phone:570-436-1635
Mailing Address - Fax:570-436-1635
Practice Address - Street 1:316 GOSHEN AVENUE
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-0603
Practice Address - Country:US
Practice Address - Phone:570-436-1635
Practice Address - Fax:570-434-1635
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044209L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012719660004Medicaid
138534OtherMED PLUS UNISON
001393OtherFIRST PRIORITY HEALTH
001393OtherFIRST PRIORITY HEALTH