Basic Information
Provider Information
NPI: 1164419032
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTAGNA
FirstName: CARMEL
MiddleName: L.
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1245 S CEDAR CREST BLVD
Address2: SUITE #301
City: ALLENTOWN
State: PA
PostalCode: 181036258
CountryCode: US
TelephoneNumber: 6104029099
FaxNumber: 6104029029
Practice Location
Address1: 400 N 17TH ST
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181045052
CountryCode: US
TelephoneNumber: 6104029099
FaxNumber: 6104029029
Other Information
ProviderEnumerationDate: 10/05/2005
LastUpdateDate: 03/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN308024LPAN Nursing Service ProvidersRegistered Nurse 
367500000X043397PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
1176600601PACAQHOTHER
134322101PAHIGHMARKOTHER
134322101PAKHP CENTRALOTHER
8283601PAGEISINGEROTHER
134322101PAFIRST PRIORITYOTHER
905927201PAAETNAOTHER
102263148000205PA MEDICAID
154458601PAGATEWAYOTHER
0322160101PACAPITAL ADVANTAGEOTHER
203588900001PAINDEP. BLUE CROSSOTHER


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