1477757870 NPI number — KATHERINE A TREHERNE MD PC

Table of content: (NPI 1477757870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477757870 NPI number — KATHERINE A TREHERNE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHERINE A TREHERNE MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KATHERINE A TREHERNE MD PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477757870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 W YORK ST
Provider Second Line Business Mailing Address:
SUITE 605
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23510-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-623-9919
Provider Business Mailing Address Fax Number:
757-623-0012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 W YORK ST
Provider Second Line Business Practice Location Address:
SUITE 605
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23510-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-623-9919
Provider Business Practice Location Address Fax Number:
757-623-0012
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TREHERNE
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER DERMATOLOGIST
Authorized Official Telephone Number:
757-623-9919

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101037473 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410989448001 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 259272 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 259273 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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