Provider Demographics
NPI:1881977742
Name:KISSMAN, KATRINA MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MAUREEN
Last Name:KISSMAN
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 1:1709 FITZWATER ST
Mailing Address - Street 2:APT A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1919
Mailing Address - Country:US
Mailing Address - Phone:215-913-6825
Mailing Address - Fax:
Practice Address - Street 1:1316 W ONTARIO ST
Practice Address - Street 2:JONES HALL, 10TH FLOOR, RM. 1001
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5220
Practice Address - Country:US
Practice Address - Phone:215-707-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451878207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine