Healthcare Provider Details

I. General information

NPI: 1912975384
Provider Name (Legal Business Name): KATHRYN ANN RANKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HALIFAX ST
PETERSBURG VA
23803-6335
US

IV. Provider business mailing address

611 MUIRFIELD CT
RICHMOND VA
23236-4167
US

V. Phone/Fax

Practice location:
  • Phone: 804-863-1652
  • Fax: 804-862-6126
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101238786
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: