Provider Demographics
NPI:1114424843
Name:DWYER, KATERINA NIKOLAEVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATERINA
Middle Name:NIKOLAEVNA
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATSIARYNA
Other - Middle Name:NIKOLAEVNA
Other - Last Name:BURAKOUSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7272
Mailing Address - Fax:
Practice Address - Street 1:100 SENTARA CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101272670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program