Individual
CARLY ELIZABETH HADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
701 OSTRUM ST STE 201, FOUNTAIN HILL, PA 18015-1152
(484) 526-6545
(484) 526-6546
Mailing address
701 OSTRUM ST STE 201, FOUNTAIN HILL, PA 18015-1152
(484) 526-6545
(484) 526-6546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0110-006780
VA
363A00000X
Physician Assistant
Primary
MA062781
PA
Other
Enumeration date
07/31/2019
Last updated
09/01/2021
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