Provider Demographics
NPI:1407841182
Name:CARTER, CHARMAINE A (MD)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12868
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2868
Mailing Address - Country:US
Mailing Address - Phone:727-824-8357
Mailing Address - Fax:727-824-3132
Practice Address - Street 1:12450 ROOSEVELT BLVD N
Practice Address - Street 2:SUITE 308
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1902
Practice Address - Country:US
Practice Address - Phone:727-572-0900
Practice Address - Fax:727-573-1428
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374291100Medicaid
FL374291100Medicaid
FL23721WMedicare PIN