Provider Demographics
NPI:1942299623
Name:PELLETIER-DATTU, CATHERINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:PELLETIER-DATTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:ELISE
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:610-696-1177
Mailing Address - Fax:
Practice Address - Street 1:11 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-3220
Practice Address - Country:US
Practice Address - Phone:610-696-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426387207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1602742OtherCIGNA
PA7373693OtherAETNA PIN
PA101504541Medicaid
PA0000000169257OtherUNISON
PA1745603OtherBCBS PA
PAP00267513OtherRR MEDICARE
PA3945237OtherAETNA PVN
PA707495OtherUPMC
PA1542731OtherGATEWAY
I33960Medicare UPIN
PA092338JK6Medicare ID - Type Unspecified
PAP00267513OtherRR MEDICARE