Provider Demographics
NPI:1598982647
Name:CATTELL, MARK JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:CATTELL
Suffix:
Gender:M
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 1:1001 ROUTE 9 N STE 101
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3301
Mailing Address - Country:US
Mailing Address - Phone:732-780-2355
Mailing Address - Fax:
Practice Address - Street 1:1001 US HIGHWAY 9 STE 101
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731
Practice Address - Country:US
Practice Address - Phone:732-780-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00174400363A00000X
FLPA9110208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant