Provider Demographics
NPI:1144452590
Name:ASTORINO, MEGHAN E (PA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:ASTORINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:E
Other - Last Name:TAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1123
Mailing Address - Country:US
Mailing Address - Phone:610-379-0200
Mailing Address - Fax:610-379-0216
Practice Address - Street 1:1001 MAHONING ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1123
Practice Address - Country:US
Practice Address - Phone:610-379-0200
Practice Address - Fax:610-379-0216
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
PAMA054121363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical