Provider Demographics
NPI:1467408534
Name:CLARICK, CAROLYN J (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:CLARICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:MOUNT KISCO MEDICAL GROUP PC
Mailing Address - Street 2:90 SOUTH BEDFORD RD
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3412
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:MOUNT KISCO MEDICAL GROUP PC
Practice Address - Street 2:90 SOUTH BEDFORD ROAD
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110213587OtherMEDICARE RAILROAD
NY02109653Medicaid
NY0667910001OtherDME
NY0667910001OtherDME
NY110213587OtherMEDICARE RAILROAD