Healthcare Provider Details

I. General information

NPI: 1639763899
Provider Name (Legal Business Name): KATHERINE M MCCROARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 07/22/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633D MEDICAL GROUP 77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23665
US

IV. Provider business mailing address

633D MEDICAL GROUP 77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23665
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-2123
  • Fax:
Mailing address:
  • Phone: 757-764-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101276419
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101276419
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: