Provider Demographics
NPI:1164954764
Name:GHEYSENS, KATHERINE MARY (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:GHEYSENS
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 1:1945 ROUTE 70 E STE D
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2160
Mailing Address - Country:US
Mailing Address - Phone:856-237-8045
Mailing Address - Fax:856-237-8047
Practice Address - Street 1:1945 ROUTE 70 E STE D
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2160
Practice Address - Country:US
Practice Address - Phone:856-237-8045
Practice Address - Fax:856-237-8047
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11501900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology