1720254006 NPI number — RYAN CARTER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720254006 NPI number — RYAN CARTER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CARTER

Provider First Name:

RYAN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1720254006

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/27/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

20 YORK STREET, CB-2041

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NEW HAVEN

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06510-3220

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-688-1734

Provider Business Mailing Address Fax Number:

203-688-9638

Provider First Line Business Practice Location Address:

593 EDDY ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PROVIDENCE

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02903-4923

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-519-1604

Provider Business Practice Location Address Fax Number:

401-272-0538

Provider Enumeration Date:

05/06/2008

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  49973 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207P00000X , with the licence number: 228944 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207P00000X , with the licence number: MD13052 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10/27/2009 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: RC76597 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
• Identifier: 11/02/2009 . This is a "BCBS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 110082578A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 939025129 . This is a "UEMF RI MEDICARE GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 04/15/2009 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 1962455022 . This is a "UEMF GROUP NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 011211701 . This is a "RI MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 09/10/2009 . This is a "NHPRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".