Provider Demographics
NPI:1801995782
Name:LORBER, KATHERINE CHASTAIN (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CHASTAIN
Last Name:LORBER
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 1:1044 SIR FRANCIS DRAKE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1454
Mailing Address - Country:US
Mailing Address - Phone:415-457-1101
Mailing Address - Fax:
Practice Address - Street 1:1044 SIR FRANCIS DRAKE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1454
Practice Address - Country:US
Practice Address - Phone:415-457-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG423812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42381OtherMEDICAL LICENSE NUMBER