Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D84945 | MD |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MT222603 | PA |
NPI | 1124412036 |
---|---|
Provider Name | Kristen Diane Coletti |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 12/07/2021 |