Healthcare Provider Details

I. General information

NPI: 1952742363
Provider Name (Legal Business Name): NICHOLAS CARRA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 MAIN ST
SPRINGFIELD MA
01107-1137
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0900
  • Fax: 413-794-2996
Mailing address:
  • Phone: 413-794-3909
  • Fax: 413-794-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA4726
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: