Individual
SHAWN M CARPENTER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6703 LONDON RD, SOUTH CHARLESTON, OH 45368-9632
(937) 536-1928
Mailing address
6703 LONDON RD, SOUTH CHARLESTON, OH 45368-9632
(937) 536-1928
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1204566
CONTRACT NUMBER
OH
Enumeration date
09/11/2020
Last updated
09/11/2020
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