MEDICARE: CATHY RENEE GOLLADAY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA12473	TX

General Provider Information

NPI Number	:	1669620696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY RENEE GOLLADAY PA-C

Provider Business Mailing Address
First Line	:	28809 GREENBERRY DR
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20882-2312
Country	:	US
Telephone Number	:	240-207-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 WESTPORT PKWY
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-4513
Country	:	US
Telephone Number	:	204-207-3755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	01/27/2025

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