Provider Demographics
NPI:1801171962
Name:CASTAGNERO, MEGHAN P (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:P
Last Name:CASTAGNERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1123
Mailing Address - Country:US
Mailing Address - Phone:717-692-4761
Mailing Address - Fax:717-692-2381
Practice Address - Street 1:1000 EVELYN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1258
Practice Address - Country:US
Practice Address - Phone:717-692-4761
Practice Address - Fax:717-692-2381
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055139363A00000X
PAOA003790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103381502Medicaid