Provider Demographics
NPI:1457352429
Name:CARR, REX GARDNER (MD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:GARDNER
Last Name:CARR
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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-0870
Mailing Address - Country:US
Mailing Address - Phone:603-643-5254
Mailing Address - Fax:603-643-5264
Practice Address - Street 1:10 COVE DR
Practice Address - Street 2:
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753-5428
Practice Address - Country:US
Practice Address - Phone:603-643-5254
Practice Address - Fax:603-643-5264
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7980208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002540Medicaid
NH80000488Medicaid
VT1002540Medicaid