Provider Demographics
NPI:1285736090
Name:GONZALEZ, KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GONZALEZ
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 1:162 HEGEMAN AVE
Mailing Address - Street 2:#100
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 HEGEMAN AVE
Practice Address - Street 2:#100
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3156
Practice Address - Country:US
Practice Address - Phone:802-655-1356
Practice Address - Fax:802-655-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine