Provider Demographics
NPI:1346596483
Name:CHARLES L. CARR JR, DO, PA
Entity Type:Organization
Organization Name:CHARLES L. CARR JR, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:207-985-0011
Mailing Address - Street 1:P.O. BOX 800
Mailing Address - Street 2:SUITE 404 LAFAYETTE CENTER
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-0800
Mailing Address - Country:US
Mailing Address - Phone:207-985-0011
Mailing Address - Fax:207-985-5111
Practice Address - Street 1:2 MAIN STREET
Practice Address - Street 2:SUITE 404 LAFAYETTE CENTER
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-985-0011
Practice Address - Fax:207-985-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1555204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty