Healthcare Provider Details

I. General information

NPI: 1679553739
Provider Name (Legal Business Name): KATHLEEN A MCCRAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 21ST ST NW
WASHINGTON DC
20052-1044
US

IV. Provider business mailing address

800 21ST ST NW
WASHINGTON DC
20052-0028
US

V. Phone/Fax

Practice location:
  • Phone: 202-994-5300
  • Fax:
Mailing address:
  • Phone: 202-994-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35538
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01012557564
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: