Provider Demographics
NPI:1679594212
Name:MCDONALD, KATE KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:KATHLEEN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KATHLEEN
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:380 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5591
Mailing Address - Country:US
Mailing Address - Phone:985-690-6600
Mailing Address - Fax:985-690-9860
Practice Address - Street 1:380 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5591
Practice Address - Country:US
Practice Address - Phone:985-690-6600
Practice Address - Fax:985-690-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16771207ND0900X
LAMD016771207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351733Medicaid
LA52344OtherMEDICARE
LAB89528Medicare UPIN