Provider Demographics
NPI:1912252487
Name:CARPENTER, ANTHONY MACK
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MACK
Last Name:CARPENTER
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 1:41 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1405
Mailing Address - Country:US
Mailing Address - Phone:716-881-5430
Mailing Address - Fax:
Practice Address - Street 1:920 HARLEM RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14224-1008
Practice Address - Country:US
Practice Address - Phone:716-332-3991
Practice Address - Fax:716-831-8666
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292135164W00000X
NY901059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse