Provider Demographics
NPI:1467017533
Name:MATHIAS, LAUREN CATHERINE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CATHERINE
Last Name:MATHIAS
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 1:109 MOUNTAIN LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:PA
Mailing Address - Zip Code:15542-8205
Mailing Address - Country:US
Mailing Address - Phone:814-926-3361
Mailing Address - Fax:
Practice Address - Street 1:329 S PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2262
Practice Address - Country:US
Practice Address - Phone:814-445-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant