Provider Demographics
NPI:1164443586
Name:DORSEY, CARRIE D (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:D
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:D
Other - Last Name:HIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-0000
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411450700Medicaid
MD891078-01OtherBC/BS
MDS062-0301OtherBC/BS REGIONAL
MD411450700Medicaid
MDO348Medicare PIN
MD159156Y1PMedicare PIN