Provider Demographics
NPI:1326677899
Name:CARTER MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:CARTER MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:856-305-1600
Mailing Address - Street 1:321 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GIBBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08027-2007
Mailing Address - Country:US
Mailing Address - Phone:856-335-2288
Mailing Address - Fax:856-335-2267
Practice Address - Street 1:321 E BROAD ST
Practice Address - Street 2:
Practice Address - City:GIBBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08027-2007
Practice Address - Country:US
Practice Address - Phone:856-305-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0759571Medicaid