Provider Demographics
NPI:1528231990
Name:KATHERINE A. TREHERNE, MD., PC
Entity Type:Organization
Organization Name:KATHERINE A. TREHERNE, MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:TREHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-827-5626
Mailing Address - Street 1:2207 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2478
Mailing Address - Country:US
Mailing Address - Phone:757-827-5626
Mailing Address - Fax:757-827-3330
Practice Address - Street 1:2207 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2478
Practice Address - Country:US
Practice Address - Phone:757-827-5626
Practice Address - Fax:757-827-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2011-02-09
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
VA005902134Medicaid
VA259273OtherANTHEM BCBS
VA259272OtherANTHEM BCBS
VA005902142Medicaid
VA259272OtherANTHEM BCBS