Provider Demographics
NPI:1114903770
Name:TODARO, CAROLYN (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TODARO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:420 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-1010
Mailing Address - Country:US
Mailing Address - Phone:724-872-4725
Mailing Address - Fax:
Practice Address - Street 1:1645 ROSTRAVER RD STE 202
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15012-9655
Practice Address - Country:US
Practice Address - Phone:724-929-2260
Practice Address - Fax:724-929-3474
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005940W363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100981047Medicaid
PA057590UUEMedicare ID - Type Unspecified
PA100981047Medicaid