Provider Demographics
NPI:1205321288
Name:O'CARROLL, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:O'CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12824-1802
Mailing Address - Country:US
Mailing Address - Phone:518-683-0618
Mailing Address - Fax:
Practice Address - Street 1:315 GRANT AVE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5342
Practice Address - Country:US
Practice Address - Phone:845-339-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant