Provider Demographics
NPI:1316913452
Name:MCDIVITT, CATHERINE A (MNT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:MCDIVITT
Suffix:
Gender:F
Credentials:MNT
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 517
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0517
Mailing Address - Country:US
Mailing Address - Phone:570-450-6200
Mailing Address - Fax:570-450-6207
Practice Address - Street 1:4700 UNION DEPOSIT RD
Practice Address - Street 2:SUITE 240
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-526-4474
Practice Address - Fax:717-526-4476
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP95891Medicare UPIN
PA072246MC6Medicare PIN