Provider Demographics
NPI:1447370812
Name:SURLA, CATHERINE S (MED)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:S
Last Name:SURLA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROSSITER AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2509
Mailing Address - Country:US
Mailing Address - Phone:610-933-2168
Mailing Address - Fax:610-933-2168
Practice Address - Street 1:13 ROSSITER AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2509
Practice Address - Country:US
Practice Address - Phone:610-933-2168
Practice Address - Fax:610-933-2168
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2043239000OtherINDEPENDENCE BLUE CROSS