Provider Demographics
NPI:1457817553
Name:CARPENTER, THOMAS M JR
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:CARPENTER
Suffix:JR
Gender:M
Credentials:
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 247
Mailing Address - Street 2:
Mailing Address - City:WAWARSING
Mailing Address - State:NY
Mailing Address - Zip Code:12489-0247
Mailing Address - Country:US
Mailing Address - Phone:845-647-8157
Mailing Address - Fax:
Practice Address - Street 1:7109 RTE. 209
Practice Address - Street 2:
Practice Address - City:WAWARSING
Practice Address - State:NY
Practice Address - Zip Code:12489-1248
Practice Address - Country:US
Practice Address - Phone:845-647-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721077085343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)