Provider Demographics
NPI:1821794058
Name:CARTER, KEVIN BERNARD
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BERNARD
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19217 WILLOW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1234
Mailing Address - Country:US
Mailing Address - Phone:301-828-5544
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE STE 800
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5832
Practice Address - Country:US
Practice Address - Phone:301-949-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5774225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant