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General NPI Number Information
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NPI Number | 1639205792
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Entity Type | Individual
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Provider Name | PAUL DOUGLAS CARTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 2701 HOLME AVE STE 302
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2029
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Country | US
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Telephone | 215-335-7705
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Fax |
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Provider Business Mailing Address
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Address Line | 8019 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19136-2786
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Country | US
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Telephone | 215-332-1300
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Fax | 215-332-5219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA-000216L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA001818L
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License Number State | PA
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