Provider Demographics
NPI:1073567368
Name:BIRCHENOUGH, KATHERINE HALTIWANGER (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HALTIWANGER
Last Name:BIRCHENOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:HALTIWANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:1025 VERDAE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4032
Practice Address - Country:US
Practice Address - Phone:864-864-2867
Practice Address - Fax:864-286-7551
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230330207P00000X
SC31992207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00950526OtherRAILROAD MEDICARE
SC319925Medicaid
SC319925Medicaid