Provider Demographics
NPI:1104821198
Name:KATTELMAN, MARC (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:KATTELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-3217
Mailing Address - Country:US
Mailing Address - Phone:302-537-5966
Mailing Address - Fax:
Practice Address - Street 1:RR 5 BOX 79
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-9706
Practice Address - Country:US
Practice Address - Phone:302-436-9600
Practice Address - Fax:302-436-6260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0006894207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98644Medicare UPIN