Provider Demographics
NPI:1083600266
Name:LEDERMAN, CAROL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LONGVIEW AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5002
Mailing Address - Country:US
Mailing Address - Phone:914-684-2779
Mailing Address - Fax:914-684-6859
Practice Address - Street 1:2 LONGVIEW AVE
Practice Address - Street 2:STE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5000
Practice Address - Country:US
Practice Address - Phone:914-684-2779
Practice Address - Fax:914-684-6859
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183713207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10204Medicare UPIN
740101Medicare PIN