Basic Information
| Provider Information | |||||||||
| NPI: | 1992798425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARACCIOLO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18119 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152360119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124697275 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 575 COAL VALLEY RD STE 504 | ||||||||
| Address2: | |||||||||
| City: | CLAIRTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122676810 | ||||||||
| FaxNumber: | 4122676817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA001365L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.