Provider Demographics
NPI:1366695769
Name:CAVANAUGH, CHRISTA DENISE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:DENISE
Last Name:CAVANAUGH
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6 DICKINSON DR
Mailing Address - Street 2:BLDG 300 STE 311
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9689
Mailing Address - Country:US
Mailing Address - Phone:610-558-1200
Mailing Address - Fax:610-558-7325
Practice Address - Street 1:6 DICKINSON DR
Practice Address - Street 2:BLDG 300 STE 311
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9689
Practice Address - Country:US
Practice Address - Phone:610-558-1200
Practice Address - Fax:610-558-7325
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2012-03-27
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Provider Licenses
StateLicense IDTaxonomies
PAMA053714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant