Basic Information
| Provider Information | |||||||||
| NPI: | 1639351281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EARL | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126925180 | ||||||||
| FaxNumber: | 4126927355 | ||||||||
| Practice Location | |||||||||
| Address1: | 2599 WEXFORD BAYNE RD | ||||||||
| Address2: | |||||||||
| City: | SEWICKLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151438769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249333600 | ||||||||
| FaxNumber: | 7249333621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 12/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 349540-1 | NY | N | Nursing Service Providers | Registered Nurse | 363A00000X | 004087-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | MA053025 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.