Provider Demographics
NPI:1154020840
Name:CARTER, CLARENCE PARRIN
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:PARRIN
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 1:10803 GEORGIA AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4748
Mailing Address - Country:US
Mailing Address - Phone:240-772-2122
Mailing Address - Fax:
Practice Address - Street 1:111 19TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1704
Practice Address - Country:US
Practice Address - Phone:202-766-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant