Healthcare Provider Details

I. General information

NPI: 1659379170
Provider Name (Legal Business Name): MARIA ANGELA CATOLICO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 LUCY CORR CT
CHESTERFIELD VA
23832-6657
US

IV. Provider business mailing address

6801 LUCY CORR CT
CHESTERFIELD VA
23832-6657
US

V. Phone/Fax

Practice location:
  • Phone: 804-748-1227
  • Fax: 804-717-6659
Mailing address:
  • Phone: 804-748-1227
  • Fax: 804-717-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA70353
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101239316
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: