Provider Demographics
NPI:1104225671
Name:SMITH, CAROL LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 CHEWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2760
Mailing Address - Country:US
Mailing Address - Phone:856-454-3104
Mailing Address - Fax:856-842-5298
Practice Address - Street 1:1387 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-2760
Practice Address - Country:US
Practice Address - Phone:856-454-3104
Practice Address - Fax:856-842-5298
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00614200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant