Provider Demographics
NPI:1689722001
Name:TRADER, CATHERINE R (DO)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:R
Last Name:TRADER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LENAPE ROAD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821
Mailing Address - Country:US
Mailing Address - Phone:973-786-0235
Mailing Address - Fax:973-786-0315
Practice Address - Street 1:8 LENAPE ROAD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821
Practice Address - Country:US
Practice Address - Phone:973-786-0235
Practice Address - Fax:973-786-0315
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB60024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
075843Medicare ID - Type Unspecified
F92733Medicare UPIN