Basic Information
| Provider Information | |||||||||
| NPI: | 1720254006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 YORK STREET, CB-2041 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036881734 | ||||||||
| FaxNumber: | 2036889638 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015191604 | ||||||||
| FaxNumber: | 4012720538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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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 | 207P00000X | 49973 | CT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 228944 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD13052 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | RC76597 | 05 | RI | MEDICAID | 011211701 | 01 | RI | RI MEDICARE | OTHER | 11/02/2009 | 01 | RI | BCBS | OTHER | 04/15/2009 | 01 | RI | UNITED HEALTHCARE | OTHER | 09/10/2009 | 01 | RI | NHPRI | OTHER | 939025129 | 01 | RI | UEMF RI MEDICARE GROUP | OTHER | 10/27/2009 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 1962455022 | 01 | RI | UEMF GROUP NPI | OTHER | 110082578A | 05 | MA | MEDICAID |