Provider Demographics
NPI:1811093503
Name:TROSTLE, BERNADETTE M (PA)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:TROSTLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9094
Mailing Address - Country:US
Mailing Address - Phone:570-754-7358
Mailing Address - Fax:
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-5455
Practice Address - Fax:570-622-5493
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003069L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096978MK6Medicare ID - Type UnspecifiedMEDICARE PROVDIER NUMBER