Provider Demographics
NPI:1316213937
Name:GOLDEN, KATIE EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:EILEEN
Last Name:GOLDEN
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 1:345 SHARON TOWNSHIP LN APT 455
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5192
Mailing Address - Country:US
Mailing Address - Phone:860-559-5208
Mailing Address - Fax:
Practice Address - Street 1:345 SHARON TOWNSHIP LN APT 455
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5192
Practice Address - Country:US
Practice Address - Phone:860-559-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01064207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912KOtherBCBS
NC1316213937Medicaid
NCNCT584AOtherMEDICARE PTAN
SCNC2969Medicaid