Provider Demographics
NPI:1245237783
Name:CAROLAN, PATRICK JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:CAROLAN
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 1:762 LINDLEY ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5046
Mailing Address - Country:US
Mailing Address - Phone:203-576-5131
Mailing Address - Fax:
Practice Address - Street 1:3909 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2815
Practice Address - Country:US
Practice Address - Phone:203-372-4565
Practice Address - Fax:203-372-1585
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011942207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001119429Medicaid
CT001119429Medicaid
B37861Medicare UPIN