Provider Demographics
NPI:1639351281
Name:EARL, CAROL A (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:EARL
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 1:3705 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2584
Mailing Address - Country:US
Mailing Address - Phone:412-692-5180
Mailing Address - Fax:412-692-7355
Practice Address - Street 1:2599 WEXFORD BAYNE RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8769
Practice Address - Country:US
Practice Address - Phone:724-933-3600
Practice Address - Fax:724-933-3621
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349540-1163W00000X
NY004087-1363A00000X
PAMA053025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No163W00000XNursing Service ProvidersRegistered Nurse
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant