Provider Demographics
NPI:1942434865
Name:BUCKWALTER, CAROLINE REIST (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:REIST
Last Name:BUCKWALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ELIZABETH
Other - Last Name:REIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-9308
Mailing Address - Country:US
Mailing Address - Phone:717-808-8670
Mailing Address - Fax:
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-544-4251
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant