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1104024256 NPI number — KATHLEEN DEPONTE MD

NPI Number: 1104024256
Health Care Provider/Practitioner: KATHLEEN DEPONTE MD

Information about “1104024256” NPI (KATHLEEN DEPONTE MD) exists in 1104024256 in HTML format HTML  |  1104024256 in plain Text format TXT  |  1104024256 in PDF (Portable Document Format) PDF  |  1104024256 in an XML format XML  formats.

NPI Number : 1104024256 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104024256",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEPONTE",
    "FirstName": "KATHLEEN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1301 SUNSET DR",
    "SecondLineMailingAddress": "STE 3",
    "MailingAddressCityName": "JOHNSON CITY",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37604-7906",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-979-5610",
    "MailingAddressFaxNumber": "423-926-1823",
    "FirstLinePracticeLocationAddress": "935 VIRGINIA AVE NW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24273-1818",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "276-679-2729",
    "PracticeLocationAddressFaxNumber": "276-679-0578",
    "EnumerationDate": "07/10/2007",
    "LastUpdateDate": "11/18/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "35177",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "MD35510",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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