Provider Demographics
NPI:1871532150
Name:CALDWELL, CHAD CAMERON (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:CAMERON
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:145 KIMEL PARK DR
Mailing Address - Street 2:STE 330
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6972
Mailing Address - Country:US
Mailing Address - Phone:336-765-6181
Mailing Address - Fax:336-765-8492
Practice Address - Street 1:145 KIMEL PARK DR STE 330
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6972
Practice Address - Country:US
Practice Address - Phone:336-765-6181
Practice Address - Fax:336-765-8492
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24972Medicare UPIN
NC1871532150Medicare NSC