Provider Demographics
NPI:1730868829
Name:CARTER, BRENDAN DOUGLAS
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:DOUGLAS
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 RIVIERA RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4039
Mailing Address - Country:US
Mailing Address - Phone:267-684-9141
Mailing Address - Fax:
Practice Address - Street 1:432 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1135
Practice Address - Country:US
Practice Address - Phone:570-484-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program