Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS019982 | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0102206429 | VA |
NPI | 1558882860 |
---|---|
Provider Name | Dr. Jeffrey Jason Katra |
First Address | Charlottesville, VA 22903-6414 |
Second Address | Charlottesville, VA 22901-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2017 |
Last Update Date | 02/11/2021 |