Provider Demographics
NPI:1518225895
Name:KOAH, CAITLAN LISA PYDEN (PA-C, MS)
Entity Type:Individual
Prefix:MRS
First Name:CAITLAN
Middle Name:LISA PYDEN
Last Name:KOAH
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:MS
Other - First Name:CAITLAN
Other - Middle Name:LISA
Other - Last Name:PYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MS
Mailing Address - Street 1:255 W. LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:484-565-1510
Mailing Address - Fax:484-565-1513
Practice Address - Street 1:255 W. LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:484-565-1510
Practice Address - Fax:484-565-1513
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055429363A00000X, 363A00000X
NY015577-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant