Provider Demographics
NPI:1053589945
Name:KATKOCIN, REBECCA LEIGH (PAC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEIGH
Last Name:KATKOCIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:LEIGH
Other - Last Name:KATKOCIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:4755 OGLETOWN STANTON RD STE 2670
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-2438
Mailing Address - Fax:302-733-4832
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 2670
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-2438
Practice Address - Fax:302-733-4832
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001993363A00000X
CT001993363AS0400X
DEC5-0012061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical