Provider Demographics
NPI:1417116302
Name:NADEAU, KATIE JULIA (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JULIA
Last Name:NADEAU
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 1:110 S PACA ST
Mailing Address - Street 2:EMERGENCY MEDICINE, 6TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1642
Mailing Address - Country:US
Mailing Address - Phone:856-571-4700
Mailing Address - Fax:
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:EMERGENCY MEDICINE, 6TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-8025
Practice Address - Fax:410-328-8028
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ44730207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program