MEDICARE: MARY CARVER RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004403	NY

General Provider Information

NPI Number	:	1972705812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CARVER RPA-C

Provider Business Mailing Address
First Line	:	PO BOX 13822
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07188-0001
Country	:	US
Telephone Number	:	917-510-2854
Fax Number	:	917-510-2801

Provider Business Practice Location Address
First Line	:	154 W 71ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-4005
Country	:	US
Telephone Number	:	212-496-4600
Fax Number	:	917-496-4600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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Directions to “ MARY CARVER RPA-C” Practice Location

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