Healthcare Provider Details

I. General information

NPI: 1730079377
Provider Name (Legal Business Name): CATHERINE ROSE MCGONIGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WYNCROFT DR
MEDIA PA
19063-4861
US

IV. Provider business mailing address

41 WYNCROFT DR
MEDIA PA
19063-4861
US

V. Phone/Fax

Practice location:
  • Phone: 610-674-7939
  • Fax:
Mailing address:
  • Phone: 610-674-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007928
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: