Provider Demographics
NPI:1427411891
Name:SEDLOCK, CARLY (MD)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SEDLOCK
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 1:701 OSTRUM ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1152
Mailing Address - Country:US
Mailing Address - Phone:845-266-2004
Mailing Address - Fax:833-222-9421
Practice Address - Street 1:701 OSTRUM ST STE 103
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:845-266-2004
Practice Address - Fax:833-222-9421
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473690207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease