Provider Demographics
NPI:1689608036
Name:BORN, KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BORN
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 1:1625 N. GEORGE MASON DRIVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-717-4600
Mailing Address - Fax:703-717-4601
Practice Address - Street 1:1625 N. GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 325
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-717-4600
Practice Address - Fax:703-717-4601
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC036110207V00000X
VA0101239904207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I24399Medicare UPIN
019829M65Medicare PIN