Healthcare Provider Details

I. General information

NPI: 1710199021
Provider Name (Legal Business Name): MATTHEW DAVID CARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MICHIGAN AVE
HOLLAND MI
49423-4918
US

IV. Provider business mailing address

602 MICHIGAN AVE
HOLLAND MI
49423-4918
US

V. Phone/Fax

Practice location:
  • Phone: 616-394-3185
  • Fax: 616-494-4003
Mailing address:
  • Phone: 616-394-3185
  • Fax: 616-494-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number4301098138
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301098138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: