Provider Demographics
NPI:1750416020
Name:KNODEL, KATHRYN A (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:KNODEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:DANNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2806 HILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6484
Mailing Address - Country:US
Mailing Address - Phone:706-863-0200
Mailing Address - Fax:
Practice Address - Street 1:2806 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6484
Practice Address - Country:US
Practice Address - Phone:706-863-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20188207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801007000Medicaid
KY64030570Medicaid
OH21823474Medicaid
55-0676749OtherFEDERAL TAX ID
55-0676749OtherFEDERAL TAX ID
KY64030570Medicaid