Provider Demographics
NPI:1417915455
Name:FATER, CARMEN PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN PATRICIA
Middle Name:
Last Name:FATER
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 1:10 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2518
Mailing Address - Country:US
Mailing Address - Phone:508-428-1969
Mailing Address - Fax:508-428-1962
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-2518
Practice Address - Country:US
Practice Address - Phone:508-428-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine