Provider Demographics
NPI:1568612273
Name:CASWELL, MIRIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CASWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:A
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DUMC 3961
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-668-1002
Mailing Address - Fax:919-681-1091
Practice Address - Street 1:2400 PRATT ST
Practice Address - Street 2:SUITE 9000
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3976
Practice Address - Country:US
Practice Address - Phone:919-668-1002
Practice Address - Fax:919-681-1091
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant