Provider Demographics
NPI:1902907678
Name:DEVINE FOX, KATHLEEN (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DEVINE FOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3976
Mailing Address - Country:US
Mailing Address - Phone:484-573-5116
Mailing Address - Fax:484-573-5122
Practice Address - Street 1:965 BALTIMORE PIKE
Practice Address - Street 2:SUITE 2B
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3976
Practice Address - Country:US
Practice Address - Phone:484-573-5116
Practice Address - Fax:484-573-5122
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002615L363AM0700X
PARN187628L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS77894Medicare UPIN
PAS77894Medicare UPIN