Provider Demographics
NPI:1811916158
Name:ALLEY, KATHERINE L (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:ALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 791372
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1372
Mailing Address - Country:US
Mailing Address - Phone:301-608-8375
Mailing Address - Fax:301-608-3979
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 504
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-493-8500
Practice Address - Fax:301-493-6050
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020039853OtherRAILROAD MEDICARE
MD227400100Medicaid
MD415096100Medicaid
MD234P508GMedicare ID - Type Unspecified
MD227400100Medicaid
DC019281S34Medicare ID - Type Unspecified
MD415096100Medicaid