Provider Demographics
NPI:1568663656
Name:CARSON, CECILE (CECILE CARSON, MD)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:CECILE CARSON, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7982 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-9719
Mailing Address - Country:US
Mailing Address - Phone:585-271-5650
Mailing Address - Fax:
Practice Address - Street 1:693 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2152
Practice Address - Country:US
Practice Address - Phone:585-271-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine