Healthcare Provider Details

I. General information

NPI: 1215160460
Provider Name (Legal Business Name): NATHAN PATRICK CARR PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 PENNSYLVANIA AVE
BINGHAMTON NY
13903-1645
US

IV. Provider business mailing address

33 LEWIS RD
BINGHAMTON NY
13905-1048
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-2048
  • Fax: 607-723-3496
Mailing address:
  • Phone: 607-729-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053989
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: