Individual
CALEB BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
(434) 924-9400
(434) 982-1618
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110006158
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962947507
—
VA
Enumeration date
01/05/2017
Last updated
08/02/2021
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