Provider Demographics
NPI:1871257915
Name:CARMACK, WHITNEY LEIGH (PA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEIGH
Last Name:CARMACK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:629 S 2ND ST APT B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2463
Mailing Address - Country:US
Mailing Address - Phone:301-525-4313
Mailing Address - Fax:
Practice Address - Street 1:1082 OLD CHURCHMANS RD STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2143
Practice Address - Country:US
Practice Address - Phone:302-655-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant