Provider Demographics
NPI:1942473921
Name:MACISAAC, KATHLEEN A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:MACISAAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 S RANDOLPH ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2328
Mailing Address - Country:US
Mailing Address - Phone:540-527-7323
Mailing Address - Fax:540-242-3442
Practice Address - Street 1:129 S RANDOLPH ST UNIT 6
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2328
Practice Address - Country:US
Practice Address - Phone:540-527-7323
Practice Address - Fax:540-242-3442
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49513207Y00000X
FLME0049513207Y00000X
VA0101277495207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology