Provider Demographics
NPI:1063738102
Name:XIXIS, KATHRYN L (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:XIXIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEIGH
Other - Last Name:IDOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-6089
Practice Address - Country:US
Practice Address - Phone:434-924-2706
Practice Address - Fax:434-924-9068
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012664382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063738102Medicaid
VA1063738102Medicaid
VA1063738102Medicaid