Healthcare Provider Details

I. General information

NPI: 1619567278
Provider Name (Legal Business Name): ALISON RAE KRENZER CARLEW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W 7TH ST STE 200
FREDERICK MD
21701-4106
US

IV. Provider business mailing address

1003 W 7TH ST STE 200
FREDERICK MD
21701-4106
US

V. Phone/Fax

Practice location:
  • Phone: 240-304-3327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4470
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008825
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: