Provider Demographics
NPI:1255686382
Name:BENGEL, KAREN ANN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BENGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:CUSIMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5241 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2391
Mailing Address - Country:US
Mailing Address - Phone:814-877-5100
Mailing Address - Fax:814-877-5121
Practice Address - Street 1:5241 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2391
Practice Address - Country:US
Practice Address - Phone:814-877-5100
Practice Address - Fax:814-877-5121
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant