Provider Demographics
NPI:1922197961
Name:CARPENTER, GARY G (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:CARPENTER
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:833 CHESTNUT STREET EAST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4413
Practice Address - Country:US
Practice Address - Phone:215-955-5800
Practice Address - Fax:215-923-4267
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD0276332080P0205X
PAMD027633L2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000666130Medicaid
PW0006661300013Medicaid
MD1537512Medicaid
NJ1449702Medicaid
NJ1449702Medicaid
DEC27161Medicare UPIN
MD1537512Medicaid
PW0006661300013Medicaid