Provider Demographics
NPI:1144566613
Name:KATHMAN, STEPHEN E (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:KATHMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WELLER DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-3306
Mailing Address - Country:US
Mailing Address - Phone:937-667-0400
Mailing Address - Fax:937-506-3991
Practice Address - Street 1:505 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377
Practice Address - Country:US
Practice Address - Phone:937-619-0050
Practice Address - Fax:937-619-0069
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003642RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082058Medicaid