Provider Demographics
NPI:1104825710
Name:ATKINS, CARL D (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:D
Last Name:ATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2907
Mailing Address - Country:US
Mailing Address - Phone:518-822-8484
Mailing Address - Fax:518-822-8484
Practice Address - Street 1:69 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2907
Practice Address - Country:US
Practice Address - Phone:518-822-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143253207RX0202X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00861087Medicaid
NYP00779046OtherRAILROAD MEDICARE
NYP00732601OtherRAILROAD MEDICARE
NYJ400003141Medicare PIN
NYA400010364Medicare PIN
NYP00732601OtherRAILROAD MEDICARE