Provider Demographics
NPI:1629084249
Name:DAVID, KATHERINE ETHIER (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ETHIER
Last Name:DAVID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1149
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:240-223-2639
Mailing Address - Fax:240-223-3223
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1149
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:240-223-2639
Practice Address - Fax:240-223-3223
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0055125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH06286Medicare UPIN