Healthcare Provider Details

I. General information

NPI: 1235059684
Provider Name (Legal Business Name): CAROLINE DIANE LOUISE SPEER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 HAVEN WOOD DR
ROCK HALL MD
21661-1336
US

IV. Provider business mailing address

5951 HAVEN WOOD DR
ROCK HALL MD
21661-1336
US

V. Phone/Fax

Practice location:
  • Phone: 603-493-7512
  • Fax:
Mailing address:
  • Phone: 603-493-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: