Provider Demographics
NPI:1447414255
Name:CARTER, DAVID CHANNING (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHANNING
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 1:639 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1805
Mailing Address - Country:US
Mailing Address - Phone:607-770-9899
Mailing Address - Fax:607-770-9086
Practice Address - Street 1:639 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1805
Practice Address - Country:US
Practice Address - Phone:607-770-9899
Practice Address - Fax:607-770-9086
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250009208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program