Provider Demographics
NPI:1427021724
Name:CARTER, EBONI X (MD)
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:X
Last Name:CARTER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 LONDON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3405
Mailing Address - Country:US
Mailing Address - Phone:757-861-9010
Mailing Address - Fax:757-861-9011
Practice Address - Street 1:2929 LONDON BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3405
Practice Address - Country:US
Practice Address - Phone:757-861-9010
Practice Address - Fax:757-861-9011
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010071216Medicaid
VA143466OtherANTHEM
VA78032OtherSENTARA/OPTIMA
004708B28Medicare PIN
VAI07511Medicare UPIN