Provider Demographics
NPI:1669457065
Name:CARTER, RICARDO TDD (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:TDD
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 1:310 ELECTRIC AVE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1369
Mailing Address - Country:US
Mailing Address - Phone:717-242-3760
Mailing Address - Fax:717-242-6230
Practice Address - Street 1:310 ELECTRIC AVE
Practice Address - Street 2:SUITE 231
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1369
Practice Address - Country:US
Practice Address - Phone:717-242-3760
Practice Address - Fax:717-242-6230
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041163E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA830007735OtherRAILROAD MEDICARE
PA10996OtherGEISINGER
PA0011276300004Medicaid
PA174911ZFVOOtherMEDICARE ID#
PA01001701OtherCAPITAL BLUE CROSS
PA204893OtherUPMC HEALTH PLAN
PACA174911OtherHIGHMARK BLUE SHIELD
PA0011276300004Medicaid