Provider Demographics
NPI:1518935188
Name:KATES, LISA CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CATHERINE
Last Name:KATES
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 1:2200 DEFENSE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2926
Mailing Address - Country:US
Mailing Address - Phone:410-451-5500
Mailing Address - Fax:410-451-5504
Practice Address - Street 1:2200 DEFENSE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2926
Practice Address - Country:US
Practice Address - Phone:410-451-5500
Practice Address - Fax:410-451-5504
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161955OtherPTAN
MD161955OtherPTAN
MDH40210Medicare UPIN