Basic Information
| Provider Information | |||||||||
| NPI: | 1326028119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUSTIN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | HAWKINS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 MEDICAL CIR | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406671828 | ||||||||
| FaxNumber: | 5407223658 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 MEDICAL CIR | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406671828 | ||||||||
| FaxNumber: | 5407223658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 0101032075 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 289215 | 01 | VA | ANTHEM | OTHER | 0091104000 | 01 | WV | MEDICAID | OTHER |