Provider Demographics
NPI:1639193196
Name:CAGGIANO, CHRISTOPHER J SR (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:CAGGIANO
Suffix:SR
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 QUIET CV
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7735
Mailing Address - Country:US
Mailing Address - Phone:704-786-1885
Mailing Address - Fax:704-933-5954
Practice Address - Street 1:1035 DALE EARNHARDT BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-4477
Practice Address - Country:US
Practice Address - Phone:704-933-2266
Practice Address - Fax:704-933-5954
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015VWMedicaid
NCS42302Medicare UPIN
NCC81504Medicare ID - Type Unspecified