Provider Demographics
NPI:1770507808
Name:GOETZ, CATHERINE K (PAC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:K
Last Name:GOETZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 GLEN LOCH DR
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-1774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2866 W PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-8922
Practice Address - Country:US
Practice Address - Phone:610-987-3451
Practice Address - Fax:610-987-6809
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000335L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA012597Medicare ID - Type Unspecified
PAS59696Medicare UPIN