Provider Demographics
NPI:1245750744
Name:CHATTERTON, CAROLYN GRACE (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:GRACE
Last Name:CHATTERTON
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:GRACE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 ATLANTIC AVE APT B318
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2779
Mailing Address - Country:US
Mailing Address - Phone:224-558-3052
Mailing Address - Fax:
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-3000
Practice Address - Fax:631-376-3420
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program