Healthcare Provider Details

I. General information

NPI: 1982963245
Provider Name (Legal Business Name): KATHERINE PANDELIDIS KAUFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MEDICAL LN
POLLOCKSVILLE NC
28573-8200
US

IV. Provider business mailing address

PO BOX 68
POLLOCKSVILLE NC
28573-0068
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-1010
  • Fax: 252-224-3071
Mailing address:
  • Phone: 252-633-1010
  • Fax: 252-224-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number183540
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2016-01193
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2016-01193
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number2016-01193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: