Provider Demographics
NPI:1811919012
Name:CARTER, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:349 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320-1705
Mailing Address - Country:US
Mailing Address - Phone:765-789-4541
Mailing Address - Fax:765-789-4547
Practice Address - Street 1:349 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47320-1705
Practice Address - Country:US
Practice Address - Phone:765-789-4541
Practice Address - Fax:765-789-4547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047066A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01168190OtherRAILROAD MEDICARE
IN000000678380OtherANTHEM
IN200206980Medicaid
IN000000853017OtherANTHEM
IN200206980Medicaid
IN000000853017OtherANTHEM
ING84341Medicare UPIN
ININ1754001Medicare PIN