Provider Demographics
NPI:1477757870
Name:KATHERINE A TREHERNE MD PC
Entity Type:Organization
Organization Name:KATHERINE A TREHERNE MD PC
Other - Org Name:KATHERINE A TREHERNE MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-623-9919
Mailing Address - Street 1:142 W YORK ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2015
Mailing Address - Country:US
Mailing Address - Phone:757-623-9919
Mailing Address - Fax:757-623-0012
Practice Address - Street 1:142 W YORK ST
Practice Address - Street 2:SUITE 605
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2015
Practice Address - Country:US
Practice Address - Phone:757-623-9919
Practice Address - Fax:757-623-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410989448001OtherTRICARE
VA259272OtherANTHEM BLUE CROSS
VA259273OtherANTHEM BLUE CROSS
VAB08004Medicare UPIN