Healthcare Provider Details

I. General information

NPI: 1003770801
Provider Name (Legal Business Name): CATHERINE MAHOLICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MOUNTAIN BLVD
WILKES BARRE PA
18711-0027
US

IV. Provider business mailing address

126 LEHIGH RD
GOULDSBORO PA
18424-8831
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067001
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: