Provider Demographics
NPI:1568492429
Name:CARSON, GEORGE MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:CARSON
Suffix:
Gender:M
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 1:3401 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7341
Mailing Address - Country:US
Mailing Address - Phone:216-831-5700
Mailing Address - Fax:
Practice Address - Street 1:3401 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7341
Practice Address - Country:US
Practice Address - Phone:216-831-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ19872Medicare UPIN
OHCAPA23196Medicare ID - Type Unspecified