Provider Demographics
NPI:1609300904
Name:GONSALVES, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GONSALVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100275
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0275
Mailing Address - Country:US
Mailing Address - Phone:352-627-9240
Mailing Address - Fax:352-273-8172
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-627-9240
Practice Address - Fax:352-273-8172
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME154165207ZC0500X, 207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program