MEDICARE: DR. CHARLOTTE L CASTERLINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	MD0/8852 E	PA

General Provider Information

NPI Number	:	1942204573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLOTTE L CASTERLINE MD

Provider Business Mailing Address
First Line	:	915 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-3934
Country	:	US
Telephone Number	:	570-288-9375
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-3934
Country	:	US
Telephone Number	:	570-288-9375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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