Provider Demographics
NPI:1609987015
Name:FONASH, CATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:FONASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 HAMILTON CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-7927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1724
Practice Address - Country:US
Practice Address - Phone:814-827-3400
Practice Address - Fax:814-827-3556
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040962E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP0354608OtherRAILROAD MEDICARE
PA0014374000003Medicaid
PA737917Medicare PIN
PAF53313Medicare UPIN