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NPI Code Detail

MEDICARE: MARK P CARTER MA

MEDICARE: MARK P CARTER MA
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
1231H00000XAudiologist23001896AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093791907
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK P CARTER MA
Provider Business Mailing Address
First Line : 10021 DUPONT CIRCLE CT
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1604
Country : US
Telephone Number : 260-426-8117
Fax Number : 260-420-0817
Provider Business Practice Location Address
First Line : 1306 APPLE GLEN BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1792
Country : US
Telephone Number : 260-459-6924
Fax Number : 260-459-6200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 02/19/2009

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Directions to “ MARK P CARTER MA” Practice Location

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