Provider Demographics
NPI:1316093230
Name:MARCUS, CAROLYN VENICE (PA-C, MPH)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:VENICE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:VENICE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0686
Mailing Address - Country:US
Mailing Address - Phone:336-703-3100
Mailing Address - Fax:336-727-8135
Practice Address - Street 1:799 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4206
Practice Address - Country:US
Practice Address - Phone:336-703-3100
Practice Address - Fax:336-727-8135
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100297363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCZA0000038Medicaid