Mary L Carollo, P A C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

498 Issued in CO

Practice address

175 S Union Blvd
Ste 345
Colorado Springs, CO 80910

Phone

(719) 471-7158

Fax

(719) 471-7159

NPI assigned

Jan 8, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508914904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 WILSON ROAD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809193553",
            "telephone_number": "719-548-9182",
            "fax_number": "719-593-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 S UNION BLVD",
            "address_2": "STE 345",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80910",
            "telephone_number": "719-471-7158",
            "fax_number": "719-471-7159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAROLLO",
        "first_name": "MARY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "P A C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Anne Carnick, LCSW
• Lindsey Elaine Caro
• Carol F. Myers, LPC, LLC
• Carol Starr Carpenter Counseling, Inc
• Carolina Medical Solutions
• Carolyn Abrahamzon Counseling LLC
• Carolyn Durham Inc
• Melissa Caron, LCSW
• Alicia Carpenter
• Carol Carpenter, LPC

• Surgical Physician Assistant in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Surgical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.