Provider Demographics
NPI:1114913704
Name:SCHOTTLER-THAL, CARRIN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIN
Middle Name:ELIZABETH
Last Name:SCHOTTLER-THAL
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 1:1 CLARA BARTON DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3401
Mailing Address - Country:US
Mailing Address - Phone:518-262-5588
Mailing Address - Fax:518-262-5589
Practice Address - Street 1:1 CLARA BARTON DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3401
Practice Address - Country:US
Practice Address - Phone:518-262-5588
Practice Address - Fax:518-262-5589
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225893-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02498942Medicaid
NY02498942Medicaid
NYH96467Medicare UPIN