Provider Demographics
NPI:1578568887
Name:SHEAR, CAROLE LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNNE
Last Name:SHEAR
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 1:114 E 72ND ST
Mailing Address - Street 2:STE B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4245
Mailing Address - Country:US
Mailing Address - Phone:212-472-2890
Mailing Address - Fax:212-472-1971
Practice Address - Street 1:114 E 72ND ST
Practice Address - Street 2:STE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4245
Practice Address - Country:US
Practice Address - Phone:212-472-2890
Practice Address - Fax:212-472-1971
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140666207N00000X
NJ25MA03729600207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133345147OtherUNITED HEALTHCARE
NY00471072Medicaid
NYP3600848OtherOXFORD FREEDOM
NYP3600848OtherOXFORD FREEDOM
C07068Medicare UPIN