Individual
CATHERINE J KOTALIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
540 S GOVERNORS AVE, SUITE 100, DOVER, DE 19904-3530
(302) 526-1470
(302) 674-1398
Mailing address
640 S STATE ST, ADMINISTRATION -742 BLDG, DOVER, DE 19901-3530
(302) 674-3970
(302) 672-2350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001883
IA
363A00000X
Physician Assistant
Primary
C5-0000763
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217033ZA5H
MEDICARE PTAN
DE
Enumeration date
01/23/2008
Last updated
10/19/2012
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