Provider Demographics
NPI:1609256304
Name:CASAGRANDE, AMANDA (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CASAGRANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 11TH ST
Mailing Address - Street 2:STE., C
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6179
Mailing Address - Country:US
Mailing Address - Phone:724-334-3640
Mailing Address - Fax:724-334-3644
Practice Address - Street 1:301 11TH ST
Practice Address - Street 2:STE., C
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6179
Practice Address - Country:US
Practice Address - Phone:724-334-3640
Practice Address - Fax:724-334-3644
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209554390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program