Basic Information
Provider Information
NPI: 1487031639
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAPPA
FirstName: SARAH
MiddleName: SHULMAN
NamePrefix: MRS.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SHULMAN
OtherFirstName: SARAH
OtherMiddleName: CATHERINE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 37215
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212973215
CountryCode: US
TelephoneNumber: 2024765000
FaxNumber: 2024764741
Practice Location
Address1: 111 MICHIGAN AVE NW
Address2: W3.5, 600
City: WASHINGTON
State: DC
PostalCode: 200102916
CountryCode: US
TelephoneNumber: 2024763670
FaxNumber: 2024764741
Other Information
ProviderEnumerationDate: 04/27/2015
LastUpdateDate: 09/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XMD046129DCY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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