Provider Demographics
NPI:1124826417
Name:OLAN, CAREY JAE (PA-C)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:JAE
Last Name:OLAN
Suffix:
Gender:
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 1:3716 ELM AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2275
Mailing Address - Country:US
Mailing Address - Phone:301-461-3990
Mailing Address - Fax:
Practice Address - Street 1:800 LINDEN AVE FL 8
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4622
Practice Address - Country:US
Practice Address - Phone:443-682-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0009820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant