Provider Demographics
NPI:1710937362
Name:DR.CAVINESS
Entity Type:Organization
Organization Name:DR.CAVINESS
Other - Org Name:DR.CAVINESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CAVINESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-741-1837
Mailing Address - Street 1:300 MIDDLETOWN BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3202
Mailing Address - Country:US
Mailing Address - Phone:215-741-1837
Mailing Address - Fax:215-741-1743
Practice Address - Street 1:300 MIDDLETOWN BLVD
Practice Address - Street 2:STE 102
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3202
Practice Address - Country:US
Practice Address - Phone:215-741-1837
Practice Address - Fax:215-741-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007697302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization