1568496644 NPI number — MS. CAROL L CARR

Table of content: MS. CAROL L CARR (NPI 1568496644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568496644 NPI number — MS. CAROL L CARR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
CAROL
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568496644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4949 LIBERTY LN
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
WESCOSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18106-9017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-821-9422
Provider Business Mailing Address Fax Number:
610-820-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4949 LIBERTY LN
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
WESCOSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18106-9017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-821-9422
Provider Business Practice Location Address Fax Number:
610-820-6308
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC 001259 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 534087 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 576006000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1663381 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 353221 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50025746 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 230382 . This is a "UBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7760554 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com