Provider Demographics
NPI:1508109877
Name:ETHELRED E CARTER MEDICAL CORP
Entity Type:Organization
Organization Name:ETHELRED E CARTER MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETHELRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-260-7252
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:SUITE #3700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2424
Mailing Address - Country:US
Mailing Address - Phone:323-260-7252
Mailing Address - Fax:323-260-7864
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE #3700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-260-7252
Practice Address - Fax:323-260-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29534207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83976Medicare UPIN