Healthcare Provider Details

I. General information

NPI: 1104276021
Provider Name (Legal Business Name): KATHERINE ELEANOR DERTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 L ST NW STE 700
WASHINGTON DC
20037-1543
US

IV. Provider business mailing address

5801 POSTAL RD UNIT 81310
CLEVELAND OH
44181-2112
US

V. Phone/Fax

Practice location:
  • Phone: 202-331-9293
  • Fax:
Mailing address:
  • Phone: 301-340-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301109765
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD600003438
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: