Provider Demographics
NPI:1639378250
Name:CARTER, CHRISTOPHER MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:CARTER
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 1:601 W 2ND ST RM 216
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2317
Mailing Address - Country:US
Mailing Address - Phone:812-353-9533
Mailing Address - Fax:
Practice Address - Street 1:601 W 2ND ST RM 216
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-353-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN11419207ZP0102X
FLME113183207ZP0102X
OH35.127659207ZP0213X
IN01080360A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005944500Medicaid
FLGH539ZMedicare PIN