Provider Demographics
NPI:1467033944
Name:MCCAULEY, LARRY BAUMAN III (PA-C)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:BAUMAN
Last Name:MCCAULEY
Suffix:III
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 1:3925 FRIENDSHIP PATTERSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9141
Mailing Address - Country:US
Mailing Address - Phone:336-260-9131
Mailing Address - Fax:
Practice Address - Street 1:3925 FRIENDSHIP PATTERSON MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9141
Practice Address - Country:US
Practice Address - Phone:336-260-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant