Provider Demographics
NPI:1275701922
Name:STANG-VELDHOUSE, KATHLEEYA NAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEYA
Middle Name:NAN
Last Name:STANG-VELDHOUSE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:KATHLEEYA
Other - Middle Name:NAN
Other - Last Name:STANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2616 ERWIN RD
Mailing Address - Street 2:APARTMENT #1643
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3843
Mailing Address - Country:US
Mailing Address - Phone:219-781-1752
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CAMPUS BOX 7600
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141488OtherNC LICENSE NUMBER