Provider Demographics
NPI:1235687468
Name:MAXWELL, CARLIN
Entity Type:Individual
Prefix:
First Name:CARLIN
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 182ND AVE E
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1033
Mailing Address - Country:US
Mailing Address - Phone:941-780-2782
Mailing Address - Fax:
Practice Address - Street 1:2150 TOWN SQUARE PL
Practice Address - Street 2:SUITE 290
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1465
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic