Provider Demographics
NPI:1033119219
Name:MARTIN, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:814-837-4560
Mailing Address - Fax:814-837-7905
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:814-837-4560
Practice Address - Fax:814-837-7905
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN335957L207P00000X
PAUP006967B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1068798OtherWEST VIRGINIA WORK COMP
PA500027746OtherRR MEDICARE
NY02254502OtherNY MEDICAL ASSISTANCE
PA1732836OtherBLUE SHIELD
WV1068798OtherWEST VIRGINIA WORK COMP
P53916Medicare UPIN