Provider Demographics
NPI:1811530207
Name:SEYMOUR, CARLYE BETH (PA)
Entity type:Individual
Prefix:
First Name:CARLYE
Middle Name:BETH
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARLYE
Other - Middle Name:BETH
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:86 THOMAS JOHNSON CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4348
Mailing Address - Country:US
Mailing Address - Phone:301-694-8311
Mailing Address - Fax:301-694-3537
Practice Address - Street 1:86 THOMAS JOHNSON CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-694-8311
Practice Address - Fax:301-694-3537
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4405PAMedicaid