Provider Demographics
NPI:1528422482
Name:GOULD, KATRINA MEILING (DO)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MEILING
Last Name:GOULD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MEILING
Other - Last Name:SHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2330 ROUTE 33 STE 107
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1431
Mailing Address - Country:US
Mailing Address - Phone:609-303-4401
Mailing Address - Fax:
Practice Address - Street 1:2330 ROUTE 33 STE 107
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1431
Practice Address - Country:US
Practice Address - Phone:609-303-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10580500207Q00000X
0000000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program