Provider Demographics
NPI:1760961494
Name:LEEMASTER, KATIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:LEEMASTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1449
Mailing Address - Country:US
Mailing Address - Phone:215-720-9228
Mailing Address - Fax:
Practice Address - Street 1:2440 M ST NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1449
Practice Address - Country:US
Practice Address - Phone:202-785-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031468363AS0400X
MDC0006902363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical