Provider Demographics
NPI:1740625557
Name:SIFORD, KARA E (MD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:E
Last Name:SIFORD
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:PO BOX 748613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15195 HEATHCOTE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6243
Practice Address - Country:US
Practice Address - Phone:571-284-4370
Practice Address - Fax:571-284-4387
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26906207Q00000X
390200000X
VA0101265684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV6609AOtherMEDICARE PTAN
WV003399738OtherBCBS
WV1740625557Medicaid
WV1740625557Medicaid