Healthcare Provider Details

I. General information

NPI: 1578835492
Provider Name (Legal Business Name): WILLIAM ALVIN CARTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 JOHN F KENNEDY BLVD STE 660 SUITE 660
PHILADELPHIA PA
19103-1806
US

IV. Provider business mailing address

1617 JOHN F KENNEDY BLVD STE 660 SUITE 660
PHILADELPHIA PA
19103-1806
US

V. Phone/Fax

Practice location:
  • Phone: 215-988-0080
  • Fax: 215-988-1739
Mailing address:
  • Phone: 215-988-0080
  • Fax: 215-988-1739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD035174E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: