=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548629942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER J CARTER PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2016
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25501 CHAGRIN BLVD STE 200
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-746-8537
-----------------------------------------------------
Fax | 216-450-1810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23811 CHAGRIN BLVD STE 244
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-746-8537
-----------------------------------------------------
Fax | 216-450-1810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50.004597RX
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------