Healthcare Provider Details

I. General information

NPI: 1104117910
Provider Name (Legal Business Name): JACQUELYN SARA CARR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ST LUKES BLVD
EASTON PA
18045-5671
US

IV. Provider business mailing address

1600 ST LUKES BLVD
EASTON PA
18045-5671
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-4500
  • Fax: 484-503-4501
Mailing address:
  • Phone: 484-503-4500
  • Fax: 484-503-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD471804
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD471804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: