Provider Demographics
NPI:1073520839
Name:CARTER, SAMANTHA EMILY (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EMILY
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21310 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-599-0404
Mailing Address - Fax:281-599-1655
Practice Address - Street 1:21310 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-599-0404
Practice Address - Fax:281-599-1655
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35821174400000X
TXM2578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113158Medicare PIN
AZI69059Medicare UPIN