Provider Demographics
NPI:1851493241
Name:CARTER, ANGELINE A (PAC)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 BEMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2921
Mailing Address - Country:US
Mailing Address - Phone:248-549-4725
Mailing Address - Fax:
Practice Address - Street 1:2674 BEMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2921
Practice Address - Country:US
Practice Address - Phone:248-549-4725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003199363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical