Healthcare Provider Details

I. General information

NPI: 1699451914
Provider Name (Legal Business Name): KEVIN M CARR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EAST MAIN STREET
MARATHON NY
13803
US

IV. Provider business mailing address

85 S WEST ST
HOMER NY
13077-1542
US

V. Phone/Fax

Practice location:
  • Phone: 607-849-3271
  • Fax: 607-849-6357
Mailing address:
  • Phone: 607-753-3797
  • Fax: 607-753-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number034069
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA064582
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: