Provider Demographics
NPI:1154459782
Name:SHEA, KATHARINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:MARIE
Last Name:SHEA
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 1:2815 CATES AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-7304
Mailing Address - Country:US
Mailing Address - Phone:919-515-2563
Mailing Address - Fax:919-513-1994
Practice Address - Street 1:2815 CATES AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-7304
Practice Address - Country:US
Practice Address - Phone:919-515-2563
Practice Address - Fax:919-513-1994
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25120208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E03074Medicare UPIN