Provider Demographics
NPI:1518024801
Name:GARNER, CAROL V (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:V
Last Name:GARNER
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 1:170 MORTON ST
Mailing Address - Street 2:LEMUEL SHATTUCK HOSPITAL-MEDICAL SERVICES
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:617-971-3283
Mailing Address - Fax:617-971-3861
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:LEMUEL SHATTUCK HOSPITAL-MEDICAL SERVICES
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-971-3283
Practice Address - Fax:617-971-3861
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA54221207R00000X, 207RA0401X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA50495Medicare UPIN