Basic Information
| Provider Information | |||||||||
| NPI: | 1578839718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOERBER | ||||||||
| FirstName: | CAITLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11279 PERRY HWY | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249331100 | ||||||||
| FaxNumber: | 7249331160 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 LINCOLN WAY | ||||||||
| Address2: | |||||||||
| City: | WHITE OAK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151311642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126732200 | ||||||||
| FaxNumber: | 4126733205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2012 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD454808 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.