Provider Demographics
NPI:1104117910
Name:CARR, JACQUELYN SARA (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:SARA
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ST LUKES BLVD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5671
Mailing Address - Country:US
Mailing Address - Phone:484-503-4500
Mailing Address - Fax:484-503-4501
Practice Address - Street 1:1600 ST LUKES BLVD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5671
Practice Address - Country:US
Practice Address - Phone:484-503-4500
Practice Address - Fax:484-503-4501
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4718042086X0206X, 208600000X
PA2014-012052086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery