Provider Demographics
NPI:1962463489
Name:PAUKOVITZ, CATHERINE ANN (DPM)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:PAUKOVITZ
Suffix:
Gender:F
Credentials:DPM
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 337
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29716-0337
Mailing Address - Country:US
Mailing Address - Phone:803-327-2217
Mailing Address - Fax:803-327-2272
Practice Address - Street 1:430 S HERLONG AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9446
Practice Address - Country:US
Practice Address - Phone:803-327-2217
Practice Address - Fax:803-327-2272
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC534213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5346Medicaid
SCPD5346Medicaid
SC7192Medicare ID - Type Unspecified