NPI Code Detail JSON Logo

1790205706 NPI number — KATHERINE BLAIRE EGAN MD

NPI Number: 1790205706
Health Care Provider/Practitioner: KATHERINE BLAIRE EGAN MD

Information about “1790205706” NPI (KATHERINE BLAIRE EGAN MD) exists in 1790205706 in HTML format HTML  |  1790205706 in plain Text format TXT  |  1790205706 in PDF (Portable Document Format) PDF  |  1790205706 in an XML format XML  formats.

NPI Number : 1790205706 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790205706",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EGAN",
    "FirstName": "KATHERINE",
    "MiddleName": "BLAIRE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KERWIN",
    "OtherFirstName": "KATHERINE",
    "OtherMiddleName": "BLAIRE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4506 N PENNSYLVANIA ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46205-1730",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "545 BARNHILL DRIVE, EMERSON HALL 232",
    "SecondLinePracticeLocationAddress": "IU SCHOOL OF MEDICINE",
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46202",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-278-0394",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/21/2017",
    "LastUpdateDate": "09/26/2025",
    "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": "2086S0122X",
          "TaxonomyName": "Plastic and Reconstructive Surgery Physician",
          "LicenseNumber": "01091179A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "11019435A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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