Provider Demographics
NPI:1043356843
Name:KHALIFEH, KATHERINE W (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:W
Last Name:KHALIFEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 PROSPERITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4357
Mailing Address - Country:US
Mailing Address - Phone:703-280-2841
Mailing Address - Fax:
Practice Address - Street 1:2710 PROSPERITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4357
Practice Address - Country:US
Practice Address - Phone:703-280-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252601208600000X, 208C00000X
MD000000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology