Provider Demographics
NPI:1972705812
Name:CARVER, MARY (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CARVER
Suffix:
Gender:F
Credentials:RPA-C
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 13822
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07188-0001
Mailing Address - Country:US
Mailing Address - Phone:917-510-2854
Mailing Address - Fax:917-510-2801
Practice Address - Street 1:154 W 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4005
Practice Address - Country:US
Practice Address - Phone:212-496-4600
Practice Address - Fax:917-496-4600
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant