Provider Demographics
NPI:1700824059
Name:HAHN, KATHLEEN WYCKLENDT (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WYCKLENDT
Last Name:HAHN
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 1:2900 LAMB CIRCLE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073
Mailing Address - Country:US
Mailing Address - Phone:540-633-0523
Mailing Address - Fax:540-633-0526
Practice Address - Street 1:2900 LAMB CIRCLE
Practice Address - Street 2:SUITE 380
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-633-0523
Practice Address - Fax:540-633-0526
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13766207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0064097000Medicaid
NC7614877Medicaid
VA005763525Medicaid
NC7614877Medicaid
VACB4862Medicare PIN
WVA72863Medicare UPIN
WV0064097000Medicaid