Provider Demographics
NPI:1366708836
Name:O'BRIEN, KATIE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:FRISCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:160 MILLERS RUN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1358
Mailing Address - Country:US
Mailing Address - Phone:412-564-5444
Mailing Address - Fax:412-564-5478
Practice Address - Street 1:160 MILLERS RUN RD STE 500
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1358
Practice Address - Country:US
Practice Address - Phone:412-564-5444
Practice Address - Fax:412-564-5478
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055402207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065670Medicare PIN