Provider Demographics
NPI:1588064869
Name:MOORE, CAITLIN C (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:C
Last Name:MOORE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1 BARTOL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2214
Mailing Address - Country:US
Mailing Address - Phone:610-521-8970
Mailing Address - Fax:610-521-3983
Practice Address - Street 1:1 BARTOL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2214
Practice Address - Country:US
Practice Address - Phone:610-521-8970
Practice Address - Fax:610-521-3983
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2017-02-08
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Provider Licenses
StateLicense IDTaxonomies
PAMA057053363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical