Provider Demographics
NPI:1518382811
Name:CHAMBERLAIN, CAROLINE DANA (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:DANA
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MOREHEAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:704-334-7800
Mailing Address - Fax:704-414-7512
Practice Address - Street 1:700 E MOREHEAD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2742
Practice Address - Country:US
Practice Address - Phone:704-334-7800
Practice Address - Fax:704-414-7512
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1868PAMedicaid
NC1518382811Medicaid
NC1518382811Medicaid
SC1868PAMedicaid