KALY R MACCONNELL (NPI# 1295045474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295045474 |
| Entity Type | Individual |
| Full Name | KALY R MACCONNELL |
| Other Name | KALY R LUTZ |
| Credential | PA-C |
| Practice Address |
130 S Bryn Mawr Ave Ste H321 Bryn Mawr PA 19010 |
| Mailing Address |
5458 Ridge Ave Philadelphia PA 19128-3732 |
| Practice Telephone | 4843374097 |
| Practice Fax Number | 4843374082 |
| Mailing Telephone | 2154871887 |
| Mailing Fax Number | 2154871818 |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2018-06-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | OA002538 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
MA054607 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5458 Ridge Ave, Philadelphia, PA 191283732 | 2154871887 | 2154871818 |
| Street Address |
130 S BRYN MAWR AVE STE H321 |
| City | BRYN MAWR |
| State | PA |
| Zip Code | 19010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639138829 | Michael J Larock | Internal Medicine | 130 S Bryn Mawr Ave Ste H321, Bryn Mawr, PA 19010 | 2006-03-17 |
| 1114307006 | Komal Patel | Internal Medicine | 130 S Bryn Mawr Ave Ste H321, Bryn Mawr, PA 19010 | 2015-06-04 |
| 1407168818 | Flora Yau Kurtz | Internal Medicine | 130 S Bryn Mawr Ave Ste H321, Bryn Mawr, PA 19010-3121 | 2010-07-14 |
| 1932343217 | Shanu Kohli Kurd | Internal Medicine | 130 S Bryn Mawr Ave Ste H321, Bryn Mawr, PA 19010-3121 | 2009-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003462169 | Nada Farag | Dentist | 275 S Bryn Mawr Ave., #d04, Bryn Mawr, PA 19010 | 2019-08-14 |
| 1841764669 | For Eyes Optical of Pa | Optometrist | 1211 W Lancaster Ave, Rosemont, PA 19010 | 2019-01-15 |
| 1205355617 | Julia Peyton Vollmer | Student in an Organized Health Care Education/Training Program | 415 S Ithan Ave, Bryn Mawr, PA 19010 | 2017-09-18 |
| 1235657081 | Megan Christine Rosenblatt | Nurse Practitioner | 925 W Lancaster Ave Ste 210, Bryn Mawr, PA 19010 | 2017-08-31 |
| 1720511561 | Victoria Mckenna | Nurse Practitioner | 830 Old Lancaster Rd Ste 300, Bryn Mawr, PA 19010 | 2017-04-08 |
| 1922544014 | Andrew John D'amico | Behavioral Analyst | 1030 East Lancaster Ave., Suite L-10, Bryn Mawr, PA 19010 | 2017-01-12 |
| 1487105615 | Primal Physical Therapy,llc | Physical Therapist | 1111 E Lancaster Ave, Bryn Mawr, PA 19010 | 2016-10-24 |
| 1730636234 | Denise Lindsay Currier | Optometrist | 1062 E. Lancaster Ave, Suite 15d, Rosemont, PA 19010 | 2016-09-01 |
| 1518353754 | Elise Paquin | Student in an Organized Health Care Education/Training Program | 135 S Bryn Mawr Ave Ste 205, Bryn Mawr, PA 19010 | 2015-04-14 |
| 1679980064 | Main Line Counseling Partners | Social Worker | 1084 E. Lancaster Avenue, Bryn Mawr, PA 19010 | 2014-07-17 |
| Find all providers in zip 19010 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508342577 | Katherine Lynne Mcbride | Physician Assistant | 101 S Bryn Mawr Ave Ste 260, Bryn Mawr, PA 19010-3123 | 2018-07-12 |
| 1942739321 | Elena Carolyn Adams | Physician Assistant | 130 S Bryn Mawr Ave Ste 260, Bryn Mawr, PA 19010-3121 | 2017-06-08 |
| 1649276403 | Kenneth M Toto | Physician Assistant | 101 S Bryn Mawr Ave, Ste 200, Bryn Mawr, PA 19010-3123 | 2005-06-24 |
| 1386640142 | Andrew B Newman | Physician Assistant | 931 East Haverford Rd, Ste 202, Bryn Mawr, PA 19010 | 2005-06-24 |
| 1326523978 | Megan Pennisi | Physician Assistant | 825 Old Lancaster Rd Ste 420, Bryn Mawr, PA 19010-3236 | 2018-09-29 |
| 1033697172 | Erika Rose Hiller | Physician Assistant | 130 S Bryn Mawr Ave, Bryn Mawr, PA 19010-3121 | 2018-07-31 |
| 1194276493 | Katherine Stull | Physician Assistant | 825 Old Lancaster Rd Ste 420, Bryn Mawr, PA 19010-3236 | 2016-10-21 |
| 1033668785 | Teresa Cocci | Physician Assistant | 130 S Bryn Mawr Ave, Bryn Mawr, PA 19010 | 2016-09-22 |
| 1508225640 | Eric John Greene | Physician Assistant | 138 Montrose Ave, Unit 32, Bryn Mawr, PA 19010-1558 | 2016-02-17 |
| 1477988780 | Heather Lynn Prah | Physician Assistant | 130 S Bryn Mawr Ave, Emergency Department, Bryn Mawr, PA 19010-3121 | 2013-09-05 |
| Find all providers in BRYN MAWR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.