Provider Demographics
NPI:1174615934
Name:SHRADER, CATHY DARLENE (MD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:DARLENE
Last Name:SHRADER
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 1:9131 PISCATAWAY RD STE 450
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2543
Mailing Address - Country:US
Mailing Address - Phone:301-868-6700
Mailing Address - Fax:301-868-3017
Practice Address - Street 1:9131 PISCATAWAY RD STE 450
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2543
Practice Address - Country:US
Practice Address - Phone:301-868-6700
Practice Address - Fax:301-868-3017
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053648173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G75711Medicare UPIN
808821Medicare ID - Type Unspecified