Provider Demographics
NPI:1477531697
Name:MCGLONE, CARLA H (PA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:H
Last Name:MCGLONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 409013
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9013
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:SUITE 3102
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-886-7645
Practice Address - Fax:606-886-7427
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95003257Medicaid
KY0747103Medicare PIN
P40129Medicare UPIN