1023286929 NPI number — DR. KATHERINE SPRAGUE PATIL D.O.

Table of content: DR. KATHERINE SPRAGUE PATIL D.O. (NPI 1023286929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023286929 NPI number — DR. KATHERINE SPRAGUE PATIL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATIL
Provider First Name:
KATHERINE
Provider Middle Name:
SPRAGUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPRAGUE
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023286929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19464-3241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-327-4200
Provider Business Mailing Address Fax Number:
610-327-8160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1591 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-326-8005
Provider Business Practice Location Address Fax Number:
484-945-0572
Provider Enumeration Date:
02/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  OS016020 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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