MEDICARE: ELYSE G CARTY 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	207Q00000X	Family Medicine Physician	25MA04293300	NJ

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	:	1992703177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSE G CARTY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8500-2946
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0001
Country	:	US
Telephone Number	:	609-815-7810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 THIRD STREET
Second Line	:
City	:	BORDENTOWN
State	:	NJ
Zip	:	08505-2416
Country	:	US
Telephone Number	:	609-298-2005
Fax Number	:	609-324-8267

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/13/2008

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