Provider Demographics
NPI:1821483629
Name:KATA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 PROSPERITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4358
Mailing Address - Country:US
Mailing Address - Phone:703-280-2841
Mailing Address - Fax:703-712-8304
Practice Address - Street 1:2710 PROSPERITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4358
Practice Address - Country:US
Practice Address - Phone:703-280-2841
Practice Address - Fax:703-712-8304
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101278849208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty