Healthcare Provider Details

I. General information

NPI: 1154406577
Provider Name (Legal Business Name): ALYN ROBINSON CAULK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 STATE RD
PHILADELPHIA PA
19136-3407
US

IV. Provider business mailing address

12 EVERGREEN LN
HADDONFIELD NJ
08033-1202
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-7741
  • Fax: 215-685-7739
Mailing address:
  • Phone: 856-429-7125
  • Fax: 215-685-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA053382
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: