Provider Demographics
NPI:1437227832
Name:CATHCART, KATHRYN PASSE (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PASSE
Last Name:CATHCART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:PASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 746550
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6550
Mailing Address - Country:US
Mailing Address - Phone:888-236-2263
Mailing Address - Fax:434-654-8931
Practice Address - Street 1:590 PETER JEFFERSON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4628
Practice Address - Country:US
Practice Address - Phone:434-654-8930
Practice Address - Fax:434-654-8931
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA52862363A00000X
VA0110003675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437227832Medicaid
VA1437227832Medicaid