MEDICARE: NATASHA FEWKES CARTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A140912	CA

General Provider Information

NPI Number	:	1033539184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA FEWKES CARTER M.D.

Provider Business Mailing Address
First Line	:	P.O.BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:	858-657-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	4914 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	310-701-8274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	10/23/2024

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