Provider Demographics
NPI:1679952113
Name:MCCLOSKEY, KATHRYN EILEEN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EILEEN
Last Name:MCCLOSKEY
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 1:549 E BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2905
Mailing Address - Country:US
Mailing Address - Phone:757-393-1136
Mailing Address - Fax:757-698-2498
Practice Address - Street 1:549 E BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2905
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-698-2498
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine