Healthcare Provider Details

I. General information

NPI: 1154388569
Provider Name (Legal Business Name): ANTHONY R CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 GRANDVIEW AVE SUITE 101
WATERBURY CT
06708
US

IV. Provider business mailing address

134 GRANDVIEW AVE
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8911
  • Fax: 203-574-0548
Mailing address:
  • Phone: 203-756-8911
  • Fax: 203-574-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number022574
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number022574
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: