Provider Demographics
NPI:1548405913
Name:THEVENIN, KARINE (DO)
Entity type:Individual
Prefix:DR
First Name:KARINE
Middle Name:
Last Name:THEVENIN
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:141 E EMAUS AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5824
Practice Address - Country:US
Practice Address - Phone:610-791-5930
Practice Address - Fax:610-791-2157
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014601207Q00000X
NJ25MR1155400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203743YVZ-945LMedicare PIN
PA157728YEBK - 213827Medicare PIN
MD203743ZDDB-149619Medicare PIN
PA157728YUNMMedicare PIN