Basic Information
Provider Information
NPI: 1487399101
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CATTALO
FirstName: STEPHEN
MiddleName: VINCENT
NamePrefix: MR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3421 CONCORD RD
Address2:  
City: YORK
State: PA
PostalCode: 174029001
CountryCode: US
TelephoneNumber: 7178127687
FaxNumber:  
Practice Location
Address1: 1001 S GEORGE ST
Address2:  
City: YORK
State: PA
PostalCode: 174033676
CountryCode: US
TelephoneNumber: 7178127687
FaxNumber: 7178515250
Other Information
ProviderEnumerationDate: 04/28/2022
LastUpdateDate: 08/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN610805PAN Nursing Service ProvidersRegistered Nurse 
367500000XRN610805PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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