Provider Demographics
NPI:1831771880
Name:BRIDGES, KATHLEEN (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 ARGONNE AVE NE APT 12
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2036
Mailing Address - Country:US
Mailing Address - Phone:904-571-9841
Mailing Address - Fax:
Practice Address - Street 1:3735 NAZARETH RD STE 301
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8347
Practice Address - Country:US
Practice Address - Phone:610-829-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS024050207R00000X
PAOT020607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine