Healthcare Provider Details

I. General information

NPI: 1316948524
Provider Name (Legal Business Name): KEMUEL RAY CAREY MHS PA C ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 WOODBROOKE DR
SALISBURY MD
21804-8502
US

IV. Provider business mailing address

PO BOX 69709
BALTIMORE MD
21264-9709
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-4154
  • Fax:
Mailing address:
  • Phone: 410-749-4154
  • Fax: 410-860-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC03153
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0097831
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000676
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT002217A
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051996
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: