Provider Demographics
NPI:1750422069
Name:CARTER, SAMUEL DAVID (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42798207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY106460OtherSIHO - NOTC
IN200958310Medicaid
KY000023036ROtherHUMANA - NOTC
KY00533152OtherMEDICARE - KY - NOTC
KY7100078110Medicaid
VA1750422069Medicaid
KY000000624609OtherANTHEM - NOTC
KY50025281OtherPASSPORT - NOTC
KY000000624609OtherANTHEM - NOTC