Healthcare Provider Details

I. General information

NPI: 1164166252
Provider Name (Legal Business Name): CAROLINE ROSE MCALLISTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 KISH RD
REEDSVILLE PA
17084-8943
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6797
US

V. Phone/Fax

Practice location:
  • Phone: 717-667-7720
  • Fax: 717-667-7245
Mailing address:
  • Phone: 814-231-7000
  • Fax: 814-231-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD490181
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: