Healthcare Provider Details

I. General information

NPI: 1639351281
Provider Name (Legal Business Name): CAROL A. EARL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2599 WEXFORD BAYNE RD
SEWICKLEY PA
15143-8769
US

IV. Provider business mailing address

3705 5TH AVE
PITTSBURGH PA
15213-2584
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-3600
  • Fax: 724-933-3621
Mailing address:
  • Phone: 412-692-5180
  • Fax: 412-692-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004087-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053025
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number349540-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: