Provider Demographics
NPI:1487939104
Name:BACHMAN, MARY CATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:GRATTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:701 MOORE AVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2010
Practice Address - Country:US
Practice Address - Phone:570-577-1401
Practice Address - Fax:570-577-3570
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002753363A00000X
PAMA055250363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230020F6KMedicare PIN
PAMA055250OtherMEDICAL PA-C LICENCSE
PAOA002753OtherOSTEOPATHIC PA-C LICENSE