Provider Demographics
NPI:1437193323
Name:CARL, JOHN M III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CARL
Suffix:III
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 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-5261
Practice Address - Street 1:500 MARTHA JEFFERSON DRIVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4668
Practice Address - Country:US
Practice Address - Phone:434-654-5260
Practice Address - Fax:434-654-5262
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227465208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02100Medicare UPIN
VAP00890966Medicare PIN
VAVAA103763Medicare PIN