1104322320 NPI number — KARA CALDWELL MA

Table of content: KARA CALDWELL MA (NPI 1104322320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104322320 NPI number — KARA CALDWELL MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL
Provider First Name:
KARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALDWELL-MOORE
Provider Other First Name:
KARA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104322320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4605 MACCORKLE AVE SW
Provider Second Line Business Mailing Address:
THS PHYSICIAN PARTNERS, INC.-ADMIN OFC
Provider Business Mailing Address City Name:
SOUTH CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25309-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-414-4800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 LAIDLEY ST FL 4E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-766-4560
Provider Business Practice Location Address Fax Number:
304-766-4599
Provider Enumeration Date:
04/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  798 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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