Provider Demographics
NPI:1932245933
Name:PIERCE, CARL LYNN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:LYNN
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4038
Mailing Address - Country:US
Mailing Address - Phone:610-876-5450
Mailing Address - Fax:610-876-1668
Practice Address - Street 1:500 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4038
Practice Address - Country:US
Practice Address - Phone:610-876-5450
Practice Address - Fax:610-876-1668
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030504L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01137501Medicaid
C34828Medicare UPIN
PA532301Medicare ID - Type Unspecified