Individual
KATHRYN K EISENHUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
132 ABIGAIL LN, PORT MATILDA, PA 16870
(814) 272-7100
(814) 272-6501
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101245316
VA
208000000X
Pediatrics Physician
21219
MS
208000000X
Pediatrics Physician
Primary
MD462276
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07585750
—
MS
01
—
C09463
GROUP PTAN
VA
Enumeration date
05/02/2007
Last updated
08/31/2020
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