Basic Information
| Provider Information | |||||||||
| NPI: | 1659392926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SQUIRES | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 CHESTNUT ST | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159557785 | ||||||||
| FaxNumber: | 2159559362 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 CHESTNUT ST | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159557785 | ||||||||
| FaxNumber: | 2159559362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 04/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD029556E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | MD029556E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 0077682 | 05 | NJ | MEDICAID | 101408394 | 05 | PA | MEDICAID |