Basic Information
| Provider Information | |||||||||
| NPI: | 1982963245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | PANDELIDIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68 | ||||||||
| Address2: | |||||||||
| City: | POLLOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285730068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331010 | ||||||||
| FaxNumber: | 2522243071 | ||||||||
| Practice Location | |||||||||
| Address1: | 137 MEDICAL LN | ||||||||
| Address2: | |||||||||
| City: | POLLOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285738200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331010 | ||||||||
| FaxNumber: | 2522243071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2012 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | 2016-01193 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 390200000X | 183540 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RR0500X | 2016-01193 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.