Provider Demographics
NPI:1427392034
Name:CARR, MICHAEL JAMES (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:CARR
Suffix:
Gender:M
Credentials:ACNP-BC
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 200
Mailing Address - Street 2:SOUTHCOAST PHYSICIANS GROUP, INC
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:480 HAWTHORN ST
Practice Address - Street 2:SOUTHCOAST PHYSICIANS GROUP, INC.
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3713
Practice Address - Country:US
Practice Address - Phone:508-993-3555
Practice Address - Fax:508-990-1176
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2268814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner