Provider Demographics
NPI:1881159945
Name:POWERS, CAITLIN RIESS (PA)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:RIESS
Last Name:POWERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:GLORIA
Other - Last Name:RIESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1447 YORK ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6022
Mailing Address - Country:US
Mailing Address - Phone:410-252-9090
Mailing Address - Fax:410-494-7064
Practice Address - Street 1:1407 YORK ROAD
Practice Address - Street 2:SUITE 100A
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6022
Practice Address - Country:US
Practice Address - Phone:410-252-9090
Practice Address - Fax:410-494-7064
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007027363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521084400Medicaid