Healthcare Provider Details

I. General information

NPI: 1083371454
Provider Name (Legal Business Name): KATALYST HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 RANDOM HILLS RD STE 800
FAIRFAX VA
22030-6044
US

IV. Provider business mailing address

9893 GEORGETOWN PIKE STE 143
GREAT FALLS VA
22066-2617
US

V. Phone/Fax

Practice location:
  • Phone: 202-734-1298
  • Fax:
Mailing address:
  • Phone: 703-263-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC NELSON, MD
Title or Position: COO/CMO
Credential: MD
Phone: 703-982-6988