Provider Demographics
NPI:1407855471
Name:CARTER, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:CARTER
Suffix:
Gender:M
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 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-1308
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 5-B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-09-11
Deactivation Date:2012-10-05
Deactivation Code:
Reactivation Date:2013-09-11
Provider Licenses
StateLicense IDTaxonomies
TN6641207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
030255OtherANTHEM BCBS
TN100010846Medicaid
KY64916059OtherKY MEDICAID
NC8905287Medicaid
00013859OtherNHC CARE ADMIN.
3046935OtherBS OF TN
WV3810000411Medicaid
TN3158320Medicaid
TN0100OtherJOHN DEERE
VA005745829Medicaid
WV3810000411Medicaid
B02716Medicare UPIN
VA005745829Medicaid