Provider Demographics
NPI:1194836544
Name:RIDDLE, CAROLYN C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:C
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:C
Other - Last Name:RIDDLE-BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:47 TOLL GATE STA
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5687
Mailing Address - Country:US
Mailing Address - Phone:717-569-6370
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003202L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical