Provider Demographics
NPI:1932102720
Name:KOLIBABA, KATHRYN STEGEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:STEGEN
Last Name:KOLIBABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SE 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6930
Mailing Address - Country:US
Mailing Address - Phone:360-944-9889
Mailing Address - Fax:360-944-9686
Practice Address - Street 1:210 SE 136TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6930
Practice Address - Country:US
Practice Address - Phone:360-944-9889
Practice Address - Fax:360-944-9686
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034066207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR077789Medicaid
WA1039682Medicaid
OR106779Medicare PIN
OR077789Medicaid
WAGAB14761Medicare PIN