MEDICARE: ELISA M CARTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	0110001676	VA
2	363AM0700X	Medical Physician Assistant	0110001676	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164431755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA M CARTER PA

Provider Business Mailing Address
First Line	:	PO BOX 11314
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4004
Country	:	US
Telephone Number	:	757-842-4481
Fax Number	:	757-312-3135

Provider Business Practice Location Address
First Line	:	100 PLANK BRIDGE RD
Second Line	:
City	:	CAMDEN
State	:	NC
Zip	:	27921
Country	:	US
Telephone Number	:	252-331-1829
Fax Number	:	252-331-2916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/19/2020

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Directions to “ ELISA M CARTER PA” Practice Location

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