Provider Demographics
NPI:1851301618
Name:BANDY, CARYN K (DO)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:K
Last Name:BANDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:
Other - Last Name:NICHOLLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:979 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1044
Practice Address - Country:US
Practice Address - Phone:856-629-5151
Practice Address - Fax:856-629-0281
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06951000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
070421SK3Medicare PIN
077356Medicare PIN
H86126Medicare UPIN