Provider Demographics
NPI:1083710446
Name:CARLETTA, MARIBETH A (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:A
Last Name:CARLETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIBETH
Other - Middle Name:
Other - Last Name:WIDAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 SEA MOUNTAIN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8161
Mailing Address - Country:US
Mailing Address - Phone:843-399-9696
Mailing Address - Fax:
Practice Address - Street 1:3600 SEA MOUNTAIN HWY STE B
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8161
Practice Address - Country:US
Practice Address - Phone:843-399-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006082363AS0400X
SC4711363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical