Provider Demographics
NPI:1073580833
Name:CARRERA, MARCY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:ANN
Last Name:CARRERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MOUNT CARMEL AVE BLDG 4
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1905
Mailing Address - Country:US
Mailing Address - Phone:203-582-8545
Mailing Address - Fax:860-378-2894
Practice Address - Street 1:275 MOUNT CARMEL AVE BLDG 4
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1905
Practice Address - Country:US
Practice Address - Phone:203-582-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5067OtherHEALTHNET
CTQ02987Medicare UPIN
CT97000143Medicare ID - Type Unspecified