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NPI Code Detail

MEDICARE: MR. CHARLES M CARR CDCA

MEDICARE: MR. CHARLES M CARR CDCA
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1891486700
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES M CARR CDCA
Provider Business Mailing Address
First Line : 11012 LINNET AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4865
Country : US
Telephone Number : 216-386-0648
Fax Number :
Provider Business Practice Location Address
First Line : 11012 LINNET AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4865
Country : US
Telephone Number : 216-386-0648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2023
Last Update Date : 05/19/2023

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