Provider Demographics
NPI:1780867010
Name:ROBERT J. CARPENTER MD PA
Entity type:Organization
Organization Name:ROBERT J. CARPENTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-724-5885
Mailing Address - Street 1:217 GLENN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2590
Mailing Address - Country:US
Mailing Address - Phone:301-724-5885
Mailing Address - Fax:301-759-3332
Practice Address - Street 1:911 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1817
Practice Address - Country:US
Practice Address - Phone:301-724-5885
Practice Address - Fax:301-759-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5361990001Medicare NSC
MD114NQ301Medicare PIN