Provider Demographics
NPI:1538409776
Name:CARVER, RANDA ROUNDTREE (LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:RANDA
Middle Name:ROUNDTREE
Last Name:CARVER
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6248
Mailing Address - Country:US
Mailing Address - Phone:252-435-9893
Mailing Address - Fax:
Practice Address - Street 1:208 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-335-9400
Practice Address - Fax:252-335-9404
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21742305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service