Healthcare Provider Details

I. General information

NPI: 1649751553
Provider Name (Legal Business Name): CAROLINE ELIZABETH PRYOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OXFORD DR STE 301
BETHEL PARK PA
15102-1841
US

IV. Provider business mailing address

1000 BOWER HILL ROAD ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN
PITTSBURGH PA
15243-1873
US

V. Phone/Fax

Practice location:
  • Phone: 412-942-7850
  • Fax:
Mailing address:
  • Phone: 412-942-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060013
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: