Provider Demographics
NPI:1053393223
Name:CAICEDO, CHRISTIAN HUMBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:HUMBERTO
Last Name:CAICEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2010
Mailing Address - Country:US
Mailing Address - Phone:717-988-0000
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-988-0000
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422025207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008196900003Medicaid
PA145886OtherUNISON
PA100819690Medicaid
PA1008196900001Medicaid
PA83232OtherGEISINGER
PA1533717OtherGATEWAY
PA50034081OtherCAPITAL BCBS
PA30024882OtherKEYSTONE
PA001523122OtherHIGHMARK BCBS
PA1008196900003Medicaid
PAH94366Medicare UPIN