Healthcare Provider Details

I. General information

NPI: 1083212864
Provider Name (Legal Business Name): MADELINE CINGLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PETERS ROAD SUITE 101
LITITZ PA
17543-7685
US

IV. Provider business mailing address

1701 CORNWALL RD STE 101
LEBANON PA
17042-7480
US

V. Phone/Fax

Practice location:
  • Phone: 814-360-0265
  • Fax:
Mailing address:
  • Phone: 814-360-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061753
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: