Healthcare Provider Details

I. General information

NPI: 1336620731
Provider Name (Legal Business Name): STEPHEN ALEXANDER CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 07/02/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 178-127-6877
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN612490
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: