Provider Demographics
NPI:1184860827
Name:CARTER, GEORGE L (PA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 DEEP CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-5833
Mailing Address - Country:US
Mailing Address - Phone:240-353-6977
Mailing Address - Fax:
Practice Address - Street 1:10215 DEEP CREEK CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-5833
Practice Address - Country:US
Practice Address - Phone:240-353-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant