Healthcare Provider Details

I. General information

NPI: 1104370840
Provider Name (Legal Business Name): CARA CENTRELLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 LINGLESTOWN RD SUITE 100
HARRISBURG PA
17110-9499
US

IV. Provider business mailing address

50 N 12TH ST
LEMOYNE PA
17043-1440
US

V. Phone/Fax

Practice location:
  • Phone: 717-545-4786
  • Fax: 717-545-6359
Mailing address:
  • Phone: 717-234-2561
  • Fax: 717-545-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058346
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: