Provider Demographics
NPI:1871609537
Name:RICARDO TDD CARTER MD LLC
Entity type:Organization
Organization Name:RICARDO TDD CARTER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:TDD
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-242-3760
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041163E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1151OtherGEISINGER HEALTH PLAN
PA172240OtherMEDICARE PTAN
PA1802533OtherHIGHMARK BLUE SHIELD
PA0011276300004Medicaid
PA02631300OtherCAPITAL BLUE CROSS
PA172240OtherMEDICARE PTAN
PA1802533OtherHIGHMARK BLUE SHIELD