Provider Demographics
NPI:1518100528
Name:TAKAYASU, KATHERINE WEHRI (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WEHRI
Last Name:TAKAYASU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5206
Mailing Address - Country:US
Mailing Address - Phone:203-883-0346
Mailing Address - Fax:203-343-0319
Practice Address - Street 1:745 POST RD STE A
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4745
Practice Address - Country:US
Practice Address - Phone:203-883-0346
Practice Address - Fax:203-343-0319
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260636-1202D00000X, 207Q00000X
CT051182207Q00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine