Provider Demographics
NPI:1750333902
Name:CARTER, GENA R (MD)
Entity Type:Individual
Prefix:DR
First Name:GENA
Middle Name:R
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1748
Mailing Address - Country:US
Mailing Address - Phone:617-901-0778
Mailing Address - Fax:
Practice Address - Street 1:7 DRIFTWAY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4671
Practice Address - Country:US
Practice Address - Phone:781-545-7071
Practice Address - Fax:781-545-7712
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA720002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3179737Medicaid
BC4060341OtherDEA
G63997Medicare UPIN
MAA23305Medicare PIN