Healthcare Provider Details

I. General information

NPI: 1255364139
Provider Name (Legal Business Name): THOMAS LLOYD CARTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GAINSBOROUGH SQ STE 400
CHESAPEAKE VA
23320-1714
US

IV. Provider business mailing address

PO BOX 11314
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 757-842-4499
  • Fax: 757-842-4490
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD034254E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036109169
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101257978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: