Provider Demographics
NPI:1275586489
Name:CARR, JOEL R (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:CARR
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JASMINE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5282
Mailing Address - Country:US
Mailing Address - Phone:609-744-4590
Mailing Address - Fax:856-608-7630
Practice Address - Street 1:704 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3070
Practice Address - Country:US
Practice Address - Phone:609-744-4590
Practice Address - Fax:856-608-7630
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009693L2084P0800X
NJ25MB082229002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0060757OtherLICENSE
PAOS009693LOtherLICENSE NUMBER
PA1011060160001Medicaid
NJ25MB08222900OtherLICENSE
NJ0136042Medicaid
PA1011060160001Medicaid
PAI19006Medicare UPIN