Provider Demographics
NPI:1174522791
Name:FARADY, KATHERINE K (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:FARADY
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 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:2700 W ANDERSON LN
Practice Address - Street 2:STE 403
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1159
Practice Address - Country:US
Practice Address - Phone:512-786-3498
Practice Address - Fax:512-243-7236
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9364207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G06747Medicare UPIN
TX89580JMedicare ID - Type Unspecified