Basic Information
| Provider Information | |||||||||
| NPI: | 1750992855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPRIMO | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 LIVING WATERS RD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184363907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707024592 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 S WASHINGTON AVE STE 1000 | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185053814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703432383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2020 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 000000 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.