Provider Demographics
NPI:1306891999
Name:CARTER, CHARLES THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
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 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 LEW DEWITT BLVD STE A
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-1663
Practice Address - Country:US
Practice Address - Phone:540-245-7940
Practice Address - Fax:540-245-7941
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049517207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005826535Medicaid
VA249485OtherBLUE SHIELD
VA010347386Medicaid
VAP00409447OtherRR MEDICARE
VA249485OtherBLUE SHIELD
VA930001067Medicare PIN
VAGC1100Medicare PIN
VAP00409447OtherRR MEDICARE
VA010347386Medicaid