Provider Demographics
NPI:1649201849
Name:SAHM, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SAHM
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 1:1100 N GRANT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2671
Mailing Address - Country:US
Mailing Address - Phone:302-421-4100
Mailing Address - Fax:302-421-4100
Practice Address - Street 1:1100 N GRANT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2671
Practice Address - Country:US
Practice Address - Phone:302-421-4100
Practice Address - Fax:302-421-4100
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE-C1-0007575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510064326OtherEIN
DE199387YEVDMedicare PIN
DE510064326OtherEIN