Healthcare Provider Details

I. General information

NPI: 1477963874
Provider Name (Legal Business Name): KATHRYN ELIZABETH BARLETTA M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 LAKE BOONE TRL STE 315
RALEIGH NC
27607
US

IV. Provider business mailing address

1028 BROAD BRANCH CT
MC LEAN VA
22101-2139
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-0496
  • Fax: 984-974-0499
Mailing address:
  • Phone: 703-593-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2018-00859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: