Healthcare Provider Details

I. General information

NPI: 1578072989
Provider Name (Legal Business Name): CARTER MARTENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 10/26/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 RANDOLPH RD
CHARLOTTE NC
28207-1522
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-3900
  • Fax:
Mailing address:
  • Phone: 704-377-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0010-07607
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07607
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: