Provider Demographics
NPI:1982892873
Name:BRADLEY W. CARPENTIER, M.D., INC.
Entity Type:Organization
Organization Name:BRADLEY W. CARPENTIER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARPENTIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-759-8655
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-0578
Mailing Address - Country:US
Mailing Address - Phone:831-759-8655
Mailing Address - Fax:831-759-8656
Practice Address - Street 1:344 SALINAS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2727
Practice Address - Country:US
Practice Address - Phone:831-759-8655
Practice Address - Fax:831-759-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76441208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31137ZMedicare PIN