Provider Demographics
NPI:1548268543
Name:VERDE, KATRINA (MD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:VERDE
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 1:150 MCMILLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1811
Mailing Address - Country:US
Mailing Address - Phone:740-348-4824
Mailing Address - Fax:740-348-4821
Practice Address - Street 1:150 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1811
Practice Address - Country:US
Practice Address - Phone:740-348-4824
Practice Address - Fax:740-348-4821
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08462125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine