Healthcare Provider Details

I. General information

NPI: 1851350607
Provider Name (Legal Business Name): CAROL D CORDREY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVENUE CARROLL HOSPITAL CENTER
WESTMINSTER MD
21157-5799
US

IV. Provider business mailing address

1502 S MAIN ST STE 104
MOUNT AIRY MD
21771-5374
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-6700
  • Fax: 410-871-7177
Mailing address:
  • Phone: 301-921-7900
  • Fax: 301-921-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001620
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: