MEDICARE: KATHERINE OHANLAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician	G70108	CA

General Provider Information

NPI Number	:	1467486407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE OHANLAN M.D.

Provider Business Mailing Address
First Line	:	351 HOSPITAL RD
Second Line	:	SUITE 507
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3509
Country	:	US
Telephone Number	:	949-642-1361
Fax Number	:	949-642-1608

Provider Business Practice Location Address
First Line	:	4370 ALPINE RD
Second Line	:	SUITE 104
City	:	PORTOLA VALLEY
State	:	CA
Zip	:	94028-7952
Country	:	US
Telephone Number	:	650-851-6669
Fax Number	:	650-851-9747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/27/2013

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