Provider Demographics
NPI:1992712640
Name:CARTER, ALICIA R (MD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4779 COLLINS AVE APT 2106
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3255
Mailing Address - Country:US
Mailing Address - Phone:201-306-8861
Mailing Address - Fax:305-675-0678
Practice Address - Street 1:4770 BISCAYNE BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3247
Practice Address - Country:US
Practice Address - Phone:305-680-3527
Practice Address - Fax:305-675-0678
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2141292081S0010X
FLME1354122081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12567Medicare UPIN
NY3H4781Medicare ID - Type UnspecifiedINDIV
NYWEY791Medicare ID - Type UnspecifiedGROUP #