Provider Demographics
NPI:1083706170
Name:SHERTER, CARL B (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:B
Last Name:SHERTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GRANDVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-759-3666
Mailing Address - Fax:203-759-3671
Practice Address - Street 1:170 GRANDVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-759-3666
Practice Address - Fax:203-759-3671
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13579207RC0200X
CT13759207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1137597Medicaid
E22951Medicare UPIN
290000205Medicare ID - Type Unspecified