Provider Demographics
NPI:1518937226
Name:PASCUAL, CHRISTINE V (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:V
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 GALLITZIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630
Mailing Address - Country:US
Mailing Address - Phone:814-886-8161
Mailing Address - Fax:814-886-2955
Practice Address - Street 1:1400 NINTH AVE.
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-941-8811
Practice Address - Fax:814-941-8828
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009653L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00019201790002Medicaid
PA056175OtherGROUP BILLING PROVIDER #
PA0019201790002Medicaid
PAG93188Medicare UPIN
PA026565EQWMedicare PIN
PA0019201790002Medicaid