Provider Demographics
NPI:1235459066
Name:KING, KATHLEEN P (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:KING
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 1:230 S CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9275
Mailing Address - Country:US
Mailing Address - Phone:716-592-3600
Mailing Address - Fax:716-592-3613
Practice Address - Street 1:230 S CASCADE DR
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-9275
Practice Address - Country:US
Practice Address - Phone:716-592-3600
Practice Address - Fax:716-592-3613
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD45866Medicare UPIN
OHKI0634661Medicare PIN