Provider Demographics
NPI:1437350147
Name:CARVER, ALISSA RENEE (MD)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:RENEE
Last Name:CARVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6011
Mailing Address - Country:US
Mailing Address - Phone:910-332-3664
Mailing Address - Fax:910-762-0569
Practice Address - Street 1:2212 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6011
Practice Address - Country:US
Practice Address - Phone:910-332-3660
Practice Address - Fax:910-762-0569
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110384207V00000X, 207VM0101X
NC2022-03259207VM0101X
GA071919207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146406AMedicaid