Provider Demographics
NPI:1841556925
Name:SAULTERS, KACIE JACKSON (MD)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:JACKSON
Last Name:SAULTERS
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 1:3800 RESERVOIR RD, NW
Mailing Address - Street 2:ROOM G-3041
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-444-1036
Mailing Address - Fax:202-444-5104
Practice Address - Street 1:3800 RESERVOIR RD, NW
Practice Address - Street 2:ROOM G-3041
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-1036
Practice Address - Fax:202-444-5104
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD043113208M00000X
MDD93063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist