Provider Demographics
NPI:1184945925
Name:CARTER, NILES EDEMEKA (MD)
Entity type:Individual
Prefix:DR
First Name:NILES
Middle Name:EDEMEKA
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NILES
Other - Middle Name:EDEMEKA
Other - Last Name:ITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:395 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1425
Mailing Address - Country:US
Mailing Address - Phone:317-773-0760
Mailing Address - Fax:
Practice Address - Street 1:1320 S. RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29936
Practice Address - Country:US
Practice Address - Phone:843-322-1800
Practice Address - Fax:843-986-0229
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37500207V00000X
IN01079362A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC375007Medicaid
IN300007706Medicaid