Provider Demographics
NPI:1336178755
Name:CACCAMO, LINDA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:CACCAMO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:SMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 WITMER RD
Mailing Address - Street 2:STE 220
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2279
Mailing Address - Country:US
Mailing Address - Phone:215-442-5000
Mailing Address - Fax:215-957-2875
Practice Address - Street 1:250 S 21ST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3851
Practice Address - Country:US
Practice Address - Phone:610-250-4300
Practice Address - Fax:610-250-4804
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0017904163W00000X
IL041399722163W00000X
DEL6-0A00150367500000X
IL209009608367500000X
DCRN1035967367500000X
MI4704282528367500000X
PARN620353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102681818Medicaid
PAP00962403OtherRAILROAD MEDICARE
TX193850801Medicaid
TX89164UOtherBCBS
PAP00962403OtherRAILROAD MEDICARE
TX8L15053Medicare PIN
MIMI2881032Medicare PIN
TX8K9253Medicare PIN