Provider Demographics
NPI:1619011699
Name:CARVER, MARYCOLETTE (RN)
Entity type:Individual
Prefix:
First Name:MARYCOLETTE
Middle Name:
Last Name:CARVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVERSIDE CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4962
Mailing Address - Country:US
Mailing Address - Phone:540-581-0152
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERSIDE CIR STE 102
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4962
Practice Address - Country:US
Practice Address - Phone:540-581-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001113672163W00000X
NC201368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619011699Medicaid
P16276Medicare UPIN
VA1619011699Medicaid
014658C04Medicare PIN
NC2599383Medicare ID - Type Unspecified