Provider Demographics
NPI:1821618174
Name:GREENLAND, KATHARINE (DO)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:GREENLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 OXFORD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1969
Mailing Address - Country:US
Mailing Address - Phone:234-801-2727
Mailing Address - Fax:234-801-4486
Practice Address - Street 1:340 OXFORD ST STE 120
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1969
Practice Address - Country:US
Practice Address - Phone:234-801-2727
Practice Address - Fax:234-801-4486
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty