Provider Demographics
NPI:1013117126
Name:GOTH, KAREN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARY
Last Name:GOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1901 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5067
Mailing Address - Country:US
Mailing Address - Phone:252-561-7777
Mailing Address - Fax:252-561-7778
Practice Address - Street 1:1901 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5067
Practice Address - Country:US
Practice Address - Phone:252-561-7777
Practice Address - Fax:252-561-7778
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909755Medicaid
NC2022691AMedicare UPIN