Provider Demographics
NPI:1235144635
Name:KATUSHA, KATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:KATUSHA
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 1:53 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2518
Mailing Address - Country:US
Mailing Address - Phone:703-548-6552
Mailing Address - Fax:
Practice Address - Street 1:8233 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3816
Practice Address - Country:US
Practice Address - Phone:703-556-9318
Practice Address - Fax:703-448-8839
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5861713Medicaid
VA5861713Medicaid
VA491076Medicare ID - Type Unspecified