Provider Demographics
NPI:1548517824
Name:TROTTER, KATHLEEN QUINERLY (DPM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:QUINERLY
Last Name:TROTTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1325
Mailing Address - Country:US
Mailing Address - Phone:732-996-8799
Mailing Address - Fax:
Practice Address - Street 1:167 AVENUE AT THE CMN STE 3
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4557
Practice Address - Country:US
Practice Address - Phone:732-996-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006741-1213E00000X
NJ25MD00325200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist