Provider Demographics
NPI:1508342577
Name:MCBRIDE, KATHERINE LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNNE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 OVERVIEW CIR W
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-8908
Mailing Address - Country:US
Mailing Address - Phone:717-781-5200
Mailing Address - Fax:
Practice Address - Street 1:101 S BRYN MAWR AVE STE 260
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3123
Practice Address - Country:US
Practice Address - Phone:484-337-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical