MEDICARE: MR. DOUGLAS OREN CARPENTER MS, ATC

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	2255A2300X	Athletic Trainer	RT003410	PA

General Provider Information

NPI Number	:	1700818374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS OREN CARPENTER MS, ATC

Provider Business Mailing Address
First Line	:	1107 WASHINGTON AVE
Second Line	:
City	:	MONACA
State	:	PA
Zip	:	15061-2041
Country	:	US
Telephone Number	:	724-728-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 5TH AVE
Second Line	:
City	:	NEW BRIGHTON
State	:	PA
Zip	:	15066-1929
Country	:	US
Telephone Number	:	724-847-1200
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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