Provider Demographics
NPI:1558309112
Name:CARLON, GRAZIANO CARLO (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAZIANO
Middle Name:CARLO
Last Name:CARLON
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 1:425 E 58TH ST
Mailing Address - Street 2:APT. 39A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2300
Mailing Address - Country:US
Mailing Address - Phone:212-758-0134
Mailing Address - Fax:212-758-8315
Practice Address - Street 1:425 E 58TH ST
Practice Address - Street 2:APT. 39A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2300
Practice Address - Country:US
Practice Address - Phone:212-758-0134
Practice Address - Fax:212-758-8315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128488207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGC01847V10OtherBLUE CROSS - 10 DIGITS
NYB19204Medicare UPIN
NYGC075D0510Medicare ID - Type UnspecifiedMEDICARE - 10 DIGITS
NYGC01847V10OtherBLUE CROSS - 10 DIGITS