Provider Demographics
NPI:1629055009
Name:GILLESPIE, CATHERINE A (RPAC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 MAIN ST
Mailing Address - Street 2:PO BOX 470
Mailing Address - City:BEMUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14712-9667
Mailing Address - Country:US
Mailing Address - Phone:716-386-2414
Mailing Address - Fax:716-386-2437
Practice Address - Street 1:4936 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEMUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14712-9667
Practice Address - Country:US
Practice Address - Phone:716-386-2414
Practice Address - Fax:716-386-2437
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005116363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010198101OtherUNIVERA
NY9512318OtherINDEPENDENT HEALTH
NY01578523Medicaid
NY000570059005OtherBC WESTERN NY PROVIDER #
NY000570059005OtherBC WESTERN NY PROVIDER #
NYPA0947Medicare PIN