Basic Information
Provider Information
NPI: 1497845267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEMAN
FirstName: KATHERINE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2131 S 17TH ST
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284017407
CountryCode: US
TelephoneNumber: 9107729202
FaxNumber: 9107729452
Practice Location
Address1: 2131 S 17TH ST
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284017407
CountryCode: US
TelephoneNumber: 9107729202
FaxNumber: 9107729452
Other Information
ProviderEnumerationDate: 10/13/2006
LastUpdateDate: 11/25/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0206X0099-00045NCY Allopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology

No ID Information.


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