Provider Demographics
NPI:1295149813
Name:PETER M. CARNEY, M.D. P.C.
Entity type:Organization
Organization Name:PETER M. CARNEY, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MALLISON
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-389-7737
Mailing Address - Street 1:244 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-3668
Mailing Address - Country:US
Mailing Address - Phone:574-389-7737
Mailing Address - Fax:574-389-3196
Practice Address - Street 1:244 WATERFALL DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-3668
Practice Address - Country:US
Practice Address - Phone:574-389-7737
Practice Address - Fax:574-389-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034527A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100113110Medicaid
IN100113110Medicaid