Provider Demographics
NPI:1528096625
Name:CARPENTER, JEFFREY P (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:CARPENTER
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLAZA
Practice Address - Street 2:SUITE 502
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-968-7433
Practice Address - Fax:856-365-1180
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039657E2086S0129X
NJMA084894002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6681486/4255528OtherAETNA
PA0012832600004Medicaid
NJ5251001Medicaid
NJP3947303OtherOXFORD
F27262Medicare UPIN
NJP3947303OtherOXFORD
NJ138829 AN0Medicare PIN