Provider Demographics
NPI:1235487497
Name:CACCHIO, PATRICK BRADY (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BRADY
Last Name:CACCHIO
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 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:30 DUKE MEDICINE CIR # 1A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4571
Practice Address - Country:US
Practice Address - Phone:919-684-3600
Practice Address - Fax:336-599-4778
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-03708OtherNC PHYSICIAN ASSISTANT LICENSE NUMBER