Individual
PAUL CARPENTER MACCARTY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4157 RIVER RD, SOUTH BOSTON, VA 24592-6017
(434) 572-7908
Mailing address
4157 RIVER RD, SOUTH BOSTON, VA 24592-6017
(434) 572-7908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008116
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/28/2021
Last updated
09/28/2021
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