Provider Demographics
NPI:1447208335
Name:CARR, STEVEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:CARR
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 1:1690 CROWN COLONY DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0913
Mailing Address - Country:US
Mailing Address - Phone:857-403-4600
Mailing Address - Fax:
Practice Address - Street 1:695 TRUMAN PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-3552
Practice Address - Country:US
Practice Address - Phone:617-364-4380
Practice Address - Fax:617-364-7363
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2059681Medicaid
MA2059681Medicaid
MAM09668Medicare PIN