Active NPI
Carly Jo Nola
- Medical Physician Assistant
- MC Lean, VA
National Provider Identifier
1740663939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0110-004998
- Practice address
- 1420 Spring Hill Rd Ste 210
MC Lean, VA 22102-3006 - Phone
- (703) 738-4342
- NPI assigned
- Jul 7, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110-004998 | VA | Primary |
Addresses
Primary practice location
1420 Spring Hill Rd Ste 210
MC Lean, VA 22102-3006
Mailing address
11350 McCormick Road
Executive Plaza 1, Suite 501
Hunt Valley, MD 21031
Phone (410) 329-1071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110-004998 | VA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541462400000",
"number": "1740663939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11350 MCCORMICK ROAD",
"address_2": "EXECUTIVE PLAZA 1, SUITE 501",
"city": "HUNT VALLEY",
"state": "MD",
"postal_code": "21031",
"telephone_number": "410-329-1071",
"fax_number": "410-329-1054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 SPRING HILL RD STE 210",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221023006",
"telephone_number": "703-738-4342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLA",
"first_name": "CARLY",
"middle_name": "JO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-07",
"last_updated": "2018-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "0110-004998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.