Healthcare Provider Details

I. General information

NPI: 1669909453
Provider Name (Legal Business Name): KATHARINE BAIRD HASTINGS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E. MARSHALL ST. BOX 980163
RICHMOND VA
23298
US

IV. Provider business mailing address

1250 E. MARSHALL ST. BOX 980163
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6685
  • Fax:
Mailing address:
  • Phone: 804-828-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: