Provider Demographics
NPI:1003013616
Name:WOSCHKOLUP, KATHLEEN VALESKA (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VALESKA
Last Name:WOSCHKOLUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-516-1170
Mailing Address - Fax:877-249-9483
Practice Address - Street 1:801 ROPER CREEK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6938
Practice Address - Country:US
Practice Address - Phone:864-516-1170
Practice Address - Fax:877-249-9483
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC299662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC299661Medicaid
SCAA73118157Medicare PIN