Provider Demographics
NPI:1568742914
Name:BERLIN, CAROL THUYTIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:THUYTIEN
Last Name:BERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:THUYTIEN
Other - Last Name:DAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:209 WEST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-277-4341
Mailing Address - Fax:607-277-1506
Practice Address - Street 1:209 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-277-4341
Practice Address - Fax:607-277-1506
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine