Provider Demographics
NPI:1629064571
Name:CARRIERE, EDWARD W JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:CARRIERE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:499 EAST HAMPDEN
Mailing Address - Street 2:# 320
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2793
Mailing Address - Country:US
Mailing Address - Phone:303-781-8439
Mailing Address - Fax:303-788-6115
Practice Address - Street 1:499 EAST HAMPDEN
Practice Address - Street 2:#320
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2793
Practice Address - Country:US
Practice Address - Phone:303-781-8439
Practice Address - Fax:303-788-6115
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO30907208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01309079Medicaid
F47813Medicare UPIN
365418Medicare ID - Type Unspecified