Provider Demographics
NPI:1144566613
Name:KATHMAN, STEPHEN E (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:KATHMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1356
Mailing Address - Country:US
Mailing Address - Phone:513-313-7758
Mailing Address - Fax:877-865-9852
Practice Address - Street 1:620 KLING DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4201
Practice Address - Country:US
Practice Address - Phone:937-345-3483
Practice Address - Fax:877-865-9852
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003642RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082058Medicaid