Provider Demographics
NPI:1154318475
Name:MAHALA, TERRIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:A
Last Name:MAHALA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN278948L163W00000X
PA042596367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11783686OtherCAQH
PA9128203OtherAETNA
PA0015742670003Medicaid
PA02112302OtherCAPITAL ADVANTAGE
PA0776515OtherKHP CENTRAL
PA74428OtherGEISINGER
PA0776515OtherFIRST PRIORITY
PA0776515OtherHIGHMARK
PA0800897000OtherINDEP. BLUE CROSS
PA1543250OtherGATEWAY
PA0776515OtherFIRST PRIORITY
PA0015742670003Medicaid
PA430070732Medicare PIN