Provider Demographics
NPI:1639132798
Name:PETERSON, CAROLE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:JEAN
Last Name:PETERSON
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:HIGHLAND WOMENS HEALTH
Mailing Address - Street 2:1000 SOUTH AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-602-1500
Mailing Address - Fax:
Practice Address - Street 1:2300 W JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1090
Practice Address - Country:US
Practice Address - Phone:585-602-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147731207V00000X
NC2012-00312207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0296924OtherGHI
NY000911957002OtherBC/BS OF WESTERN NEW YORK
NYD01756Medicare UPIN
NY000911957003OtherBC/BS OF WESTERN NEW YORK
NY37233CMedicare ID - Type Unspecified
NY6179OtherBC/BS
NY000911957001OtherBC/BS OF WESTERN NEW YORK
NY5531513OtherAETNA
NY102399CKOtherPREFERRED CARE
NY00831672Medicaid