1861530313 NPI number — STEPHEN B CARLTON M.S.

Table of content: STEPHEN B CARLTON M.S. (NPI 1861530313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861530313 NPI number — STEPHEN B CARLTON M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLTON
Provider First Name:
STEPHEN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1861530313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 MAIN ST
Provider Second Line Business Mailing Address:
SUITE #33
Provider Business Mailing Address City Name:
BRATTLEBORO
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05301-3908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-257-1062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #33
Provider Business Practice Location Address City Name:
BRATTLEBORO
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05301-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-257-1062
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  047-0000120 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1032745 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41506 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002758 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30009114 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002758 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 025079 . This is a "VALUEOPTIONS,INC" identifier . This identifiers is of the category "OTHER".




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