Provider Demographics
NPI:1689750853
Name:CARR, CHARLES LINDBURGH JR (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LINDBURGH
Last Name:CARR
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 GOODWINS MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-7529
Mailing Address - Country:US
Mailing Address - Phone:207-499-4144
Mailing Address - Fax:207-499-4214
Practice Address - Street 1:164 GOODWINS MILLS RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:ME
Practice Address - Zip Code:04002-7529
Practice Address - Country:US
Practice Address - Phone:207-499-4144
Practice Address - Fax:207-499-4214
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16262204D00000X
ME1555204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1689750853Medicaid
041408OtherANTHEM BCBS
4329769OtherAETNA
MM8178Medicare ID - Type Unspecified