MEDICARE: CHARISSE D CARTER DO

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	208000000X	Pediatrics Physician	0102206183	VA

General Provider Information

NPI Number	:	1922534999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSE D CARTER DO

Provider Business Mailing Address
First Line	:	1529 INTERNATIONAL BLVD STE 103
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-4802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1529 INTERNATIONAL BLVD STE 103
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-4802
Country	:	US
Telephone Number	:	757-303-2729
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	01/25/2021

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