Provider Demographics
NPI:1689639627
Name:MCNAMARA, CAREY CONNOR (PA)
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:CONNOR
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13955
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-572-8201
Mailing Address - Fax:843-797-8491
Practice Address - Street 1:100 SPRING HALL DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-572-8201
Practice Address - Fax:843-797-8491
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA643FP363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2500PAMedicaid
SC2500PAMedicaid
SC2500PAMedicaid
SC3163Medicare PIN
SCSC7802A634Medicare PIN