Provider Demographics
NPI:1932524147
Name:CARR, RACHEL KATHRYN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:KATHRYN
Last Name:CARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST STE 1020
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4310
Mailing Address - Country:US
Mailing Address - Phone:215-955-7785
Mailing Address - Fax:215-923-9362
Practice Address - Street 1:1015 CHESTNUT ST STE 1020
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-7785
Practice Address - Fax:215-923-9362
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA479929Medicare PIN