Provider Demographics
NPI:1891864930
Name:ABBOTT, CARTER OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:OWEN
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16909 LAKESIDE HILLS CT STE 407
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4661
Mailing Address - Country:US
Mailing Address - Phone:402-614-5556
Mailing Address - Fax:888-892-2149
Practice Address - Street 1:16909 LAKESIDE HILLS CT STE 407
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4661
Practice Address - Country:US
Practice Address - Phone:402-614-5556
Practice Address - Fax:888-892-2149
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22642207QA0505X
IA31698207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEG56751Medicare UPIN