Provider Demographics
NPI:1841808052
Name:MIDDLEKAUFF, CONNOR DAVID (PA)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:DAVID
Last Name:MIDDLEKAUFF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 BLACKBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3401
Mailing Address - Country:US
Mailing Address - Phone:301-331-8408
Mailing Address - Fax:
Practice Address - Street 1:6201 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2148
Practice Address - Country:US
Practice Address - Phone:214-645-8995
Practice Address - Fax:214-645-0078
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
VA1841808052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife