Provider Demographics
NPI:1013634567
Name:CARTER, MARK ADRIAN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ADRIAN
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 1:2911 FLETCHER AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4750
Mailing Address - Country:US
Mailing Address - Phone:323-974-5051
Mailing Address - Fax:
Practice Address - Street 1:2911 FLETCHER AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4750
Practice Address - Country:US
Practice Address - Phone:323-974-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide