Provider Demographics
NPI:1710114475
Name:BRISTER, KATHRIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRIEL
Middle Name:J
Last Name:BRISTER
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 1:606 STEPHEN SITTER AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1290
Mailing Address - Country:US
Mailing Address - Phone:855-393-3904
Mailing Address - Fax:
Practice Address - Street 1:606 STEPHEN SITTER AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1290
Practice Address - Country:US
Practice Address - Phone:855-393-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD046825207ZP0102X, 207ZP0102X
NJ25MA09523800207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ364855Medicare PIN