| Mary Daisy Cantey Md Carolina Medical Associates Llc | |
|
312 S Orange Ave South Orange NJ 07079-2502 | |
| (973) 532-7898 | |
| (973) 821-5999 |
| Full Name | Mary Daisy Cantey Md Carolina Medical Associates Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 312 S Orange Ave, South Orange, New Jersey |
| Authorized Official Name and Position | Mary Daisy Cantey (OWNER) |
| Authorized Official Contact | 9735327898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Daisy Cantey Md Carolina Medical Associates Llc 312 S Orange Ave South Orange NJ 07079-2502 Ph: (973) 532-7898 | Mary Daisy Cantey Md Carolina Medical Associates Llc 312 S Orange Ave South Orange NJ 07079-2502 Ph: (973) 532-7898 |
| NPI Number | 1366827313 |
|---|---|
| Provider Enumeration Date | 07/20/2015 |
| Last Update Date | 08/18/2015 |
| Medicare PECOS PAC ID | 4183931439 |
|---|---|
| Medicare Enrollment ID | O20150918000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366827313 | NPI | - | NPPES |
| 8941106 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA07425300 (New Jersey) | Primary |
| 208000000X | Pediatrics | 25MA07425300 (New Jersey) | Secondary |
| Provider Name | Mary Daisy Cantey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851422687 PECOS PAC ID: 7517159866 Enrollment ID: I20101005001264 |
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