Provider Demographics
NPI:1336858612
Name:CARTER, CARTRELL L
Entity Type:Individual
Prefix:MR
First Name:CARTRELL
Middle Name:L
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 1:723 JEFFERSON ST NW APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7725
Mailing Address - Country:US
Mailing Address - Phone:120-223-0363
Mailing Address - Fax:
Practice Address - Street 1:723 JEFFERSON ST NW APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7725
Practice Address - Country:US
Practice Address - Phone:120-223-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70520888Medicaid