Healthcare Provider Details

I. General information

NPI: 1437503422
Provider Name (Legal Business Name): KATLIN ANN O'HARA D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 01/15/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 HIGHWAY 9 BYP W
LANCASTER SC
29720-1709
US

IV. Provider business mailing address

1022 LEE ANN DR NE
CONCORD NC
28025-2911
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-1411
  • Fax:
Mailing address:
  • Phone: 704-886-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number693
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number693
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: