Provider Demographics
NPI:1508852351
Name:WERNE, CARL S (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:S
Last Name:WERNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-342-4774
Mailing Address - Fax:845-818-7555
Practice Address - Street 1:13933 17TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4604
Practice Address - Country:US
Practice Address - Phone:352-567-6763
Practice Address - Fax:352-567-2146
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053982L207P00000X
NY121194207R00000X
FLME77701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001487260Medicaid
PA819001OtherFIRST PRIORITY HEALTH
PA000534418OtherBLUE SHIELD
OH2904218Medicaid
PAP00260114OtherRAILROAD MEDICARE
PA0014872600008Medicaid
WV3810016824Medicaid
WV3810016824Medicaid
PA534418NUTMedicare PIN
OH2904218Medicaid
PA0014872600008Medicaid
PA534418NJRMedicare PIN