Provider Demographics
NPI:1912233891
Name:LELLOCK, CARLING D (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLING
Middle Name:D
Last Name:LELLOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4655 WILLIAM FLYNN HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-2243
Mailing Address - Country:US
Mailing Address - Phone:412-486-3027
Mailing Address - Fax:412-486-3089
Practice Address - Street 1:4655 WILLIAM FLYNN HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2243
Practice Address - Country:US
Practice Address - Phone:412-486-3027
Practice Address - Fax:412-486-3089
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054188363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical