Basic Information
Provider Information | |||||||||
NPI: | 1235336777 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAMMONDS | ||||||||
FirstName: | KATHLEEN | ||||||||
MiddleName: | HOLLIS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FREEMAN | ||||||||
OtherFirstName: | KATHLEEN | ||||||||
OtherMiddleName: | HOLLIS | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7068 | ||||||||
Address2: |   | ||||||||
City: | PORTSMOUTH | ||||||||
State: | VA | ||||||||
PostalCode: | 237070068 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7579239604 | ||||||||
FaxNumber: | 7575396237 | ||||||||
Practice Location | |||||||||
Address1: | 2000 MEADE PKWY STE 190 | ||||||||
Address2: |   | ||||||||
City: | SUFFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 234344259 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7579239604 | ||||||||
FaxNumber: | 7575396237 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2007 | ||||||||
LastUpdateDate: | 12/01/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/01/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 4301111818 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 390200000X | 0116019609 | VA | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RP1001X | 0101247625 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.