Provider Demographics
NPI:1417913609
Name:CARR-LOCKE, DAVID LESLIE (MD FRCP FACG MASGE)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LESLIE
Last Name:CARR-LOCKE
Suffix:
Gender:M
Credentials:MD FRCP FACG MASGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-697-0970
Mailing Address - Fax:646-697-1006
Practice Address - Street 1:1283 YORK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:646-697-0970
Practice Address - Fax:646-697-1006
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255856207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
98017Medicare UPIN