Provider Demographics
NPI:1982604310
Name:GOLD, KATHRINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:A
Last Name:GOLD
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 1:5 DEBEVOISE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4135
Mailing Address - Country:US
Mailing Address - Phone:718-963-2254
Mailing Address - Fax:718-963-2255
Practice Address - Street 1:5 DEBEVOISE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4135
Practice Address - Country:US
Practice Address - Phone:718-963-2254
Practice Address - Fax:718-963-2255
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02177700Medicaid
NY9679790OtherGHI
NY040426029608OtherFIDELIS
NY040426029608OtherFIDELIS
NY02177700Medicaid