Provider Demographics
NPI:1134187644
Name:CARPENTER, HOWARD A (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 BUCHANAN ST
Mailing Address - Street 2:CALIFORNIA PACIFIC MEDICAL CENTER, NUCLEAR MEDICINE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1925
Mailing Address - Country:US
Mailing Address - Phone:415-600-3685
Mailing Address - Fax:415-600-6598
Practice Address - Street 1:2333 BUCHANAN ST
Practice Address - Street 2:CALIFORNIA PACIFIC MEDICAL CENTER, NUCLEAR MEDICINE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1925
Practice Address - Country:US
Practice Address - Phone:415-600-3685
Practice Address - Fax:415-600-6598
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA755752085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A755750OtherBLUE SHIELD OF CA
CA1134187644Medicaid
CACL011YMedicare PIN
CACL011XMedicare PIN
CACL011WMedicare PIN
CACL011ZMedicare PIN
CA00A755750OtherBLUE SHIELD OF CA