Provider Demographics
NPI:1326152273
Name:EASTMENT, CAROLINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:T
Last Name:EASTMENT
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 1:1200 E GENESEE ST
Mailing Address - Street 2:STE 209
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1968
Mailing Address - Country:US
Mailing Address - Phone:315-471-4196
Mailing Address - Fax:315-471-0845
Practice Address - Street 1:1200 E GENESEE ST
Practice Address - Street 2:STE 209
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1968
Practice Address - Country:US
Practice Address - Phone:315-471-4196
Practice Address - Fax:315-471-0845
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166288208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00964347Medicaid
NY54796EMedicare ID - Type Unspecified
NYF74965Medicare UPIN