Provider Demographics
NPI:1174588115
Name:CARTER, COLEMAN D (MD)
Entity type:Individual
Prefix:
First Name:COLEMAN
Middle Name:D
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7085
Mailing Address - Fax:704-384-7089
Practice Address - Street 1:210 E TRADE ST
Practice Address - Street 2:SUITE D-230
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2404
Practice Address - Country:US
Practice Address - Phone:704-384-7085
Practice Address - Fax:704-384-7089
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7921515Medicaid
SC135360Medicaid
NC2052207Medicare ID - Type Unspecified
SC135360Medicaid