Provider Demographics
NPI:1629063649
Name:ACKLER, FREDERICK C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:C
Last Name:ACKLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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:2005-09-15
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN215511L163W00000X
PA032399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0580612OtherFIRST PRIORITY
PA0580612OtherKHP CENTRAL
PA9986446OtherAETNA
PA82826OtherGEISINGER
PA0017672090003Medicaid
PA03221001OtherCAPITAL ADVANTAGE
PA0751635000OtherINDEP. BLUE CROSS
PA11802961OtherCAQH
PA0580612OtherHIGHMARK
PA1585084OtherGATEWAY
PA03221001OtherCAPITAL ADVANTAGE
PA0580612OtherKHP CENTRAL
PA9986446OtherAETNA