MEDICARE: PETER M. CARNEY, M.D. P.C.

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	174400000X	Specialist	01034527A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1295149813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER M. CARNEY, M.D. P.C.

Provider Business Mailing Address
First Line	:	244 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3668
Country	:	US
Telephone Number	:	574-389-7737
Fax Number	:	574-389-3196

Provider Business Practice Location Address
First Line	:	244 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3668
Country	:	US
Telephone Number	:	574-389-7737
Fax Number	:	574-389-3196

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER MALLISON CARNEY
Credential	:	MD
Telephone Number	:	574-389-7737

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	08/04/2015

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