Healthcare Provider Details

I. General information

NPI: 1225525496
Provider Name (Legal Business Name): SHAUN ERIC CARPENTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAUN E CARPENTER DO

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GREEN HILLS DR
VERONA VA
24482-2654
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7425
  • Fax: 540-245-7430
Mailing address:
  • Phone: 540-245-7425
  • Fax: 540-245-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0102206856
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102206856
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: