Provider Demographics
NPI:1225058415
Name:VALENTINO, CAROL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL ANN
Middle Name:
Last Name:VALENTINO
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 1:620 MADISON ST
Mailing Address - Street 2:MEDICAL CLINIC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2319
Mailing Address - Country:US
Mailing Address - Phone:315-426-7797
Mailing Address - Fax:315-426-6855
Practice Address - Street 1:620 MADISON ST
Practice Address - Street 2:MEDICAL CLINIC
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2319
Practice Address - Country:US
Practice Address - Phone:315-426-7797
Practice Address - Fax:315-426-6855
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC0570Medicare PIN
E37670Medicare UPIN