Provider Demographics
NPI:1386798171
Name:ZELLER, KATHLEEN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:ZELLER
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:PO BOX 39234
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-9234
Mailing Address - Country:US
Mailing Address - Phone:336-963-5625
Mailing Address - Fax:
Practice Address - Street 1:1912 EASTCHESTER DR STE 302
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3505
Practice Address - Country:US
Practice Address - Phone:336-438-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00068207V00000X, 2083P0500X
NC200700068208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906226Medicaid
2576622Medicare UPIN