Healthcare Provider Details

I. General information

NPI: 1174012132
Provider Name (Legal Business Name): CODY PAUL CARTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BARKS RD W
MARION OH
43302-7367
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7980
  • Fax: 740-383-3040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number34.014756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: