Provider Demographics
NPI:1609042852
Name:HARRISON-RESTELLI, CATHERINE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LYNN
Last Name:HARRISON-RESTELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE PPE # 211
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:443-849-2368
Mailing Address - Fax:443-849-2248
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE PPE # 211
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:443-849-2368
Practice Address - Fax:443-849-2248
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD690842084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD031797700Medicaid
MD180203Y5MMedicare PIN