Provider Demographics
NPI:1215905997
Name:CAUDILL, JOSEPH DUANE (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DUANE
Last Name:CAUDILL
Suffix:
Gender:M
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 1:3107 CAPE HILL CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1152
Mailing Address - Country:US
Mailing Address - Phone:443-291-6075
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL AVE
Practice Address - Street 2:CARROLL HOSPITAL CENTER
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5726
Practice Address - Country:US
Practice Address - Phone:410-871-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052023363A00000X
MDC0002419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095618EZ3Medicare ID - Type Unspecified
MD941GMedicare PIN
MD489P941GMedicare PIN
MDH450C526Medicare ID - Type Unspecified
P45666Medicare UPIN