Basic Information
| Provider Information | |||||||||
| NPI: | 1689672800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500-2946 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191780001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098157810 | ||||||||
| FaxNumber: | 6093248267 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 THIRD ST | ||||||||
| Address2: | |||||||||
| City: | BORDENTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085051321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092982005 | ||||||||
| FaxNumber: | 6093248267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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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 | 207Q00000X | 25MA04091000 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0163856 | 05 | NJ | MEDICAID |