Provider Demographics
NPI:1891029260
Name:WILLIAR, KATELYN PENNISI (PA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:PENNISI
Last Name:WILLIAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:N
Other - Last Name:PENNISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20010 CENTURY BLVD
Mailing Address - Street 2:SUITE 200 EMERGENCY MEDICINE ASSOCIATES
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:5255 LOUGHBORO RD., NW
Practice Address - Street 2:SIBLEY MEMORIAL HOSPITAL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:240-537-4088
Practice Address - Fax:240-537-4588
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003165363AM0700X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC166435YWHMedicare PIN