Provider Demographics
NPI:1952534612
Name:KANE-CIVITANO, CAROLINE F (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:F
Last Name:KANE-CIVITANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NEWTOWN RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4194
Mailing Address - Country:US
Mailing Address - Phone:203-790-4511
Mailing Address - Fax:
Practice Address - Street 1:105 NEWTOWN RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4194
Practice Address - Country:US
Practice Address - Phone:203-790-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010710363AM0700X
CT001106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001106OtherCT LICENSE
NY010710OtherLICENSE
NYMS0551641OtherDEA