Healthcare Provider Details

I. General information

NPI: 1033539184
Provider Name (Legal Business Name): NATASHA FEWKES CARTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA MARIE FEWKES

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 SW 1ST AVE
PORTLAND OR
97239-2883
US

IV. Provider business mailing address

P.O.BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 310-701-8274
  • Fax:
Mailing address:
  • Phone: 858-657-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA140912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: