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General NPI Number Information
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NPI Number | 1982685236
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Entity Type | Individual
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Provider Name | MARK MERRITT CARPENTER MD
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Gender | Male
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 BOB WALLACE AVE SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3843
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Country | US
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Telephone | 256-533-0335
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Fax | 256-539-9880
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Provider Business Mailing Address
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Address Line | 420 LOWELL DR SE STE 103
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3754
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Country | US
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Telephone | 256-535-5940
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Fax | 256-535-5954
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9843
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License Number State | AL
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