MEDICARE: DR. COURTNEY CECILE 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	2085R0202X	Diagnostic Radiology Physician	A81990	CA
2	2085R0202X	Diagnostic Radiology Physician	0101265908	VA

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	:	1740212372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY CECILE CARTER M.D.

Provider Business Mailing Address
First Line	:	22100 BOTHELL EVERETT HWY
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98021-8431
Country	:	US
Telephone Number	:	208-416-2932
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 AVION WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115
Country	:	US
Telephone Number	:	855-687-7237
Fax Number	:	855-673-9190

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/25/2023

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