Provider Demographics
NPI:1689650335
Name:HUCKEL, CHARLES E (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HUCKEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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:2005-12-15
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-512651-L163W00000X
PA052618367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7546776OtherAETNA
PA1478124OtherHIGHMARK
PA3659OtherGEISINGER
PA1027807630001Medicaid
PA2169343000OtherIBC
PA1478124OtherFIRST PRIORITY
PA11803028OtherCAQH
PA1581510OtherGATEWAY
PA50056826OtherCAPITAL ADVANTAGE
PA11803028OtherCAQH
PA1027807630001Medicaid
PA1581510OtherGATEWAY