Provider Demographics
NPI:1437236023
Name:AVERY, CAROLYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:L
Last Name:AVERY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQAMEDICARE COMPLIANCE UNIT 6 WEST ATTN:THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4909
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:10810 CONNECTICUT AVENUE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2138
Practice Address - Country:US
Practice Address - Phone:301-929-7100
Practice Address - Fax:301-929-7114
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD050591208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13873Medicare UPIN
014638K92Medicare ID - Type Unspecified