Provider Demographics
NPI:1013013713
Name:CARON, MARY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:CARON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CARON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:201 N PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9633
Mailing Address - Country:US
Mailing Address - Phone:207-294-1860
Mailing Address - Fax:541-622-3656
Practice Address - Street 1:201 N PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-9633
Practice Address - Country:US
Practice Address - Phone:207-294-1860
Practice Address - Fax:541-622-3656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232133204D00000X
ORDO169680204D00000X, 208D00000X
NYDO169680208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI19873Medicare UPIN
NY896941Medicare PIN