Provider Demographics
NPI:1053611939
Name:SMORE, KATHRYN M (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:SMORE
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:825 OLD LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-642-1090
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-642-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00247000363A00000X
PAMA055027363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant