Provider Demographics
NPI:1083625842
Name:KATER, MITCHELL J (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:KATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 WARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2832
Mailing Address - Country:US
Mailing Address - Phone:215-643-1245
Mailing Address - Fax:
Practice Address - Street 1:2275 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-2643
Practice Address - Country:US
Practice Address - Phone:609-890-0200
Practice Address - Fax:609-890-8335
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04495400207L00000X
PAMD028706E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6986200Medicaid
NJKA849100Medicare ID - Type Unspecified
C27755Medicare UPIN
NJ6986200Medicaid