1902863566 NPI number — DR. NATHANIEL CARTER M.D.

Table of content: DR. NATHANIEL CARTER M.D. (NPI 1902863566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902863566 NPI number — DR. NATHANIEL CARTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
NATHANIEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1902863566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21282-5980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-740-1000
Provider Business Mailing Address Fax Number:
410-740-1003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10724 LITTLE PATUXENT PKWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-740-1000
Provider Business Practice Location Address Fax Number:
410-740-1003
Provider Enumeration Date:
04/27/2006

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: 2084N0400X , with the licence number:  D46633 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 105602100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740455039 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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