Provider Demographics
NPI:1760579429
Name:MATTHEW L CARR MD PA
Entity Type:Organization
Organization Name:MATTHEW L CARR MD PA
Other - Org Name:DIAGNOSTIC CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-731-1101
Mailing Address - Street 1:3001 NW 49 AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-731-1101
Mailing Address - Fax:954-915-1129
Practice Address - Street 1:3001 NW 49 AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-731-1101
Practice Address - Fax:954-915-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0444979-00Medicaid
FL0444979-00Medicaid
D53744Medicare UPIN