Provider Demographics
NPI:1295000511
Name:CAREY, ABIGAIL SOUTHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:SOUTHARD
Last Name:CAREY
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 1:1510 LEXINGTON AVE
Mailing Address - Street 2:APT 9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7149
Mailing Address - Country:US
Mailing Address - Phone:774-217-0039
Mailing Address - Fax:
Practice Address - Street 1:26 REICHERT CIR
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2643
Practice Address - Country:US
Practice Address - Phone:774-217-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT648492080P0203X
NY272725208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04130365Medicaid