Provider Demographics
NPI:1376555490
Name:CATALANO, KATHLEEN M (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CATALANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2315
Mailing Address - Country:US
Mailing Address - Phone:518-736-1374
Mailing Address - Fax:518-762-1133
Practice Address - Street 1:41 S PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2315
Practice Address - Country:US
Practice Address - Phone:518-736-1374
Practice Address - Fax:518-762-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184092-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01698195Medicaid
NYF65611Medicare UPIN
NY01698195Medicaid