Healthcare Provider Details

I. General information

NPI: 1952507097
Provider Name (Legal Business Name): JENNIFER CARTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 02/27/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W CORK ST SUITE 270
WINCHESTER VA
22601-3870
US

IV. Provider business mailing address

PO BOX 37517
BALTIMORE MD
21297-3517
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-5121
  • Fax: 540-536-5129
Mailing address:
  • Phone: 540-536-7670
  • Fax: 540-536-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS015857
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102204063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: