MEDICARE: COLE CARTER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208100000X	Physical Medicine & Rehabilitation Physician	DO4056	ME

General Provider Information

NPI Number	:	1972111896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLE CARTER

Provider Business Mailing Address
First Line	:	84 KELLEY RD
Second Line	:
City	:	ORONO
State	:	ME
Zip	:	04473-3416
Country	:	US
Telephone Number	:	760-504-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 KELLEY RD
Second Line	:
City	:	ORONO
State	:	ME
Zip	:	04473-3416
Country	:	US
Telephone Number	:	207-973-8998
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	06/11/2025

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Directions to “ COLE CARTER ” Practice Location

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