Provider Demographics
NPI:1376601427
Name:CARL H VICTOR MD, PA
Entity Type:Organization
Organization Name:CARL H VICTOR MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-882-5800
Mailing Address - Street 1:34 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2503
Mailing Address - Country:US
Mailing Address - Phone:609-882-5800
Mailing Address - Fax:609-882-5808
Practice Address - Street 1:34 SCOTCH RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-2503
Practice Address - Country:US
Practice Address - Phone:609-882-5800
Practice Address - Fax:609-882-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03570800207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2276101Medicaid
B34515Medicare UPIN
NJ2276101Medicaid