Healthcare Provider Details

I. General information

NPI: 1942123948
Provider Name (Legal Business Name): KEVIN CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LANCASTER PIKE
WILMINGTON DE
19805-1511
US

IV. Provider business mailing address

3101 W 3RD ST
WILMINGTON DE
19805-1705
US

V. Phone/Fax

Practice location:
  • Phone: 302-842-2390
  • Fax:
Mailing address:
  • Phone: 302-300-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2498
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: