Provider Demographics
NPI:1114303401
Name:CARR, PAUL JEROME JR (CPT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JEROME
Last Name:CARR
Suffix:JR
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 N HIL MAR CIR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2968
Mailing Address - Country:US
Mailing Address - Phone:301-404-7646
Mailing Address - Fax:
Practice Address - Street 1:5818 ALLENTOWN WAY
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20748-2614
Practice Address - Country:US
Practice Address - Phone:301-404-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18753MD171W00000X, 225500000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No171W00000XOther Service ProvidersContractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer