Provider Demographics
NPI:1952329062
Name:PAUL, KATHLEEN PHILLIPS (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:PHILLIPS
Last Name:PAUL
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 1:1701 THOMSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1118
Mailing Address - Country:US
Mailing Address - Phone:434-200-5925
Mailing Address - Fax:434-200-5929
Practice Address - Street 1:1701 THOMSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1118
Practice Address - Country:US
Practice Address - Phone:434-200-5925
Practice Address - Fax:434-200-5929
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010265681Medicaid
VA194407OtherANTHEM BCBS NUMBER
VA194407OtherANTHEM BCBS NUMBER
VAI27555Medicare UPIN