Provider Demographics
NPI:1073588596
Name:CARPENTER, MYLA (MD)
Entity Type:Individual
Prefix:
First Name:MYLA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:
Practice Address - Street 1:711 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3632
Practice Address - Country:US
Practice Address - Phone:410-247-5602
Practice Address - Fax:410-242-1756
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
T016-0002OtherBCBS-DC
0403153OtherEVERCARE
MD363271700Medicaid
093N-411710-03OtherCAREFIRST BCBS OF MD
MD41171003OtherBCBS
KGO1ER-411710-03OtherCAREFIRST BCBS OF MD
MD008203100Medicaid
MDD05929Medicare UPIN
MD41171003OtherBCBS
093N-411710-03OtherCAREFIRST BCBS OF MD
MD363271700Medicaid