Provider Demographics
NPI:1851350607
Name:CORDREY, CAROL D (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:CORDREY
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 1:1502 S MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5374
Mailing Address - Country:US
Mailing Address - Phone:301-921-7900
Mailing Address - Fax:301-921-7915
Practice Address - Street 1:200 MEMORIAL AVENUE
Practice Address - Street 2:CARROLL HOSPITAL CENTER
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5799
Practice Address - Country:US
Practice Address - Phone:410-871-6700
Practice Address - Fax:410-871-7177
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD568LH114Medicare ID - Type Unspecified
S43347Medicare UPIN