Provider Demographics
NPI:1326013285
Name:WEISENBURGER, KATHLEEN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:WEISENBURGER
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 1:709 W ORCHARD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-788-6958
Mailing Address - Fax:360-733-5587
Practice Address - Street 1:709 W ORCHARD DR STE 4
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1766
Practice Address - Country:US
Practice Address - Phone:360-788-6958
Practice Address - Fax:360-733-5587
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60157877207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX807102OtherBCBS OF TEXAS
TX807102OtherBCBS OF TEXAS
TXE04450Medicare UPIN
TX100938301Medicaid
TX8069B0Medicare PIN
TXTXB113248Medicare PIN
TX110217965Medicare PIN
TX100938303Medicaid
TX807102Medicare PIN