Basic Information
Provider Information
NPI: 1508392440
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CATALANO
FirstName: ANNA
MiddleName: CATHERINE
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 809 82ND PKWY
Address2:  
City: MYRTLE BEACH
State: SC
PostalCode: 295724607
CountryCode: US
TelephoneNumber: 8436921000
FaxNumber:  
Practice Location
Address1: 809 82ND PKWY
Address2:  
City: MYRTLE BEACH
State: SC
PostalCode: 295724607
CountryCode: US
TelephoneNumber: 8436921000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2017
LastUpdateDate: 03/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207Q00000X83175SCY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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