Provider Demographics
NPI:1154406577
Name:CAULK, ALYN ROBINSON (MD)
Entity type:Individual
Prefix:
First Name:ALYN
Middle Name:ROBINSON
Last Name:CAULK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1202
Mailing Address - Country:US
Mailing Address - Phone:856-429-7125
Mailing Address - Fax:215-685-7739
Practice Address - Street 1:7901 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3407
Practice Address - Country:US
Practice Address - Phone:215-685-7741
Practice Address - Fax:215-685-7739
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6854206Medicaid
F38180Medicare UPIN
PACA - 112357Medicare ID - Type Unspecified
NJCA-855389Medicare ID - Type Unspecified