Provider Demographics
NPI:1942204573
Name:CASTERLINE, CHARLOTTE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:L
Last Name:CASTERLINE
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 1:915 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3934
Mailing Address - Country:US
Mailing Address - Phone:570-288-9375
Mailing Address - Fax:
Practice Address - Street 1:915 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-3934
Practice Address - Country:US
Practice Address - Phone:570-288-9375
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0/8852 E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067104Medicare ID - Type Unspecified
B34800Medicare UPIN