Basic Information
| Provider Information | |||||||||
| NPI: | 1427392034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL RD STE 200 | ||||||||
| Address2: | SOUTHCOAST PHYSICIANS GROUP, INC | ||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089732001 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 HAWTHORN ST | ||||||||
| Address2: | SOUTHCOAST PHYSICIANS GROUP, INC. | ||||||||
| City: | NORTH DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027473713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089933555 | ||||||||
| FaxNumber: | 5089901176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN2268814 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.