Individual
KATHLEEN D ETZEL
Active
Individual
KATHLEEN D ETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
MD049657L
PA
2085N0904X
Nuclear Radiology Physician
MD049657L
PA
2085P0229X
Pediatric Radiology Physician
MD049657L
PA
2085R0202X
Diagnostic Radiology Physician
Primary
MD049657L
PA
2085R0204X
Vascular & Interventional Radiology Physician
MD049657L
PA
2085U0001X
Diagnostic Ultrasound Physician
MD049657L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018069510004
MA
—
05
—
0018069510004
—
PA
01
—
141309
BLUE SHIELD
—
01
—
P00143495
RR MEDICARE
—
Enumeration date
05/05/2006
Last updated
10/25/2007
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