Provider Demographics
NPI:1821318395
Name:TRASOLINE, CRYSTAL M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:TRASOLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:BYERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:MEDMARK TREATMENT CENTERS
Mailing Address - Street 2:1037 COMPASS CIRCLE
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-834-1144
Mailing Address - Fax:
Practice Address - Street 1:MEDMARK TREATMENT CENTERS
Practice Address - Street 2:1037 COMPAS CIRCLE
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-834-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000948363A00000X
PAMA050990363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP91267Medicare UPIN
PA070457Medicare PIN