Provider Demographics
NPI:1659362572
Name:COX, CARLA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LYNN
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JUNIPER LANE
Mailing Address - Street 2:LIGONIER VALLEY LEARNING CENTER INC
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658
Mailing Address - Country:US
Mailing Address - Phone:724-238-5556
Mailing Address - Fax:724-238-9533
Practice Address - Street 1:117 JUNIPER LANE
Practice Address - Street 2:LIGONIER VALLEY LEARNING CENTER INC
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658
Practice Address - Country:US
Practice Address - Phone:724-238-5556
Practice Address - Fax:724-238-9533
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037749E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01225972Medicaid
E73807Medicare UPIN
607350Medicare ID - Type Unspecified