Provider Demographics
NPI:1699741132
Name:MCENTEE, KATHLEEN P (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:P
Last Name:MCENTEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-7114
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-7114
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101033046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherTRICARE/CHAMPUS
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
VA006026516Medicaid
NC06421OtherBC/BS
NC8906421Medicaid
VA227464OtherUHC - MAMSI
VAPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA081963OtherANTHEM
VA12098OtherSENTARA - OPTIMA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCORVEL/CORCARE
VAPAROtherUSA MANAGED CARE
VA227464OtherUHC - MAMSI
VA081963OtherANTHEM