Healthcare Provider Details

I. General information

NPI: 1942204573
Provider Name (Legal Business Name): CHARLOTTE L CASTERLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WYOMING AVE
FORTY FORT PA
18704-3934
US

IV. Provider business mailing address

915 WYOMING AVE
FORTY FORT PA
18704-3934
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-9375
  • Fax:
Mailing address:
  • Phone: 570-288-9375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD0/8852 E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: