Individual
DR. KATHLEEN BANNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
560 PIERCE ST, KINGSTON, PA 18704-5716
(570) 283-2161
Mailing address
34 S RAILROAD ST, TAMAQUA, PA 18252-1927
(570) 645-1950
(570) 645-1950
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD485646
PA
390200000X
Student in an Organized Health Care Education/Training Program
MT222612
PA
Other
Enumeration date
05/10/2021
Last updated
08/13/2024
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