Healthcare Provider Details

I. General information

NPI: 1932524147
Provider Name (Legal Business Name): RACHEL KATHRYN CARR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CHESTNUT ST STE 1020
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

1015 CHESTNUT ST STE 1020
PHILADELPHIA PA
19107-4310
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7785
  • Fax: 215-923-9362
Mailing address:
  • Phone: 215-955-7785
  • Fax: 215-923-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: