Provider Demographics
NPI:1720213986
Name:KOMIS, KATHERINE BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BENNETT
Last Name:KOMIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:BENNETT
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 G ST NW
Mailing Address - Street 2:SUITE 200 EAST
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4545
Mailing Address - Country:US
Mailing Address - Phone:202-660-0005
Mailing Address - Fax:202-660-0025
Practice Address - Street 1:1001 G ST NW
Practice Address - Street 2:SUITE 200 EAST
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4545
Practice Address - Country:US
Practice Address - Phone:202-660-0005
Practice Address - Fax:202-660-0025
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD040385207R00000X
VA0101252120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program