Provider Demographics
NPI:1053482950
Name:DUFF, KATHERINE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:DUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4955
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001705363AS0400X
VA0110003282363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053482950OtherANTHEM MEDIGAP
VAP00857192OtherRAILROAD MEDICARE
1053482950OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1053482950OtherMEDICAID QMB
VA1053482950OtherAETNA
VA1053482950OtherOPTIMA HEALTH PLAN
VA1053482950OtherUMWA
VA540506332115OtherTRICARE/CHAMPUS
VA1053482950OtherINTOTAL
VA371194700OtherBLACK LUNG
VA1053482950OtherHUMANA MEDICARE
VAVAA100431Medicare PIN