Provider Demographics
NPI:1649412115
Name:ELEEY, CATHARINE CLARE (MD)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:CLARE
Last Name:ELEEY
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:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1676 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1506
Practice Address - Country:US
Practice Address - Phone:610-644-9233
Practice Address - Fax:610-735-0938
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD100208D00000X
WAMD60287285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9851WMedicaid
WA0295867OtherL&I AND CRIME VICTIMS
WA1649412115Medicaid
WAG8910069Medicare PIN