Provider Demographics
NPI:1871586206
Name:QUEEN, KATE T (MD)
Entity type:Individual
Prefix:DR
First Name:KATE
Middle Name:T
Last Name:QUEEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 9TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4188
Mailing Address - Country:US
Mailing Address - Phone:919-285-0855
Mailing Address - Fax:949-561-4669
Practice Address - Street 1:811 9TH ST STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4188
Practice Address - Country:US
Practice Address - Phone:919-285-0855
Practice Address - Fax:949-561-4669
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3270693OtherUNITED HEALTHCARE
NC8969575Medicaid
NC69575OtherBLUE CROSS
3270693OtherUNITED HEALTHCARE
NC209763AMedicare ID - Type Unspecified