Provider Demographics
NPI:1124102934
Name:PIATT, CAROL LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:PIATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8301 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2902
Mailing Address - Country:US
Mailing Address - Phone:703-560-3372
Mailing Address - Fax:703-560-3373
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-560-3372
Practice Address - Fax:703-560-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02205C01Medicare PIN