Provider Demographics
NPI:1982690533
Name:ROY-BORNSTEIN, CAROLYN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ROY-BORNSTEIN
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 1:288 GROVELAND ST
Mailing Address - Street 2:C-3
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6674
Mailing Address - Country:US
Mailing Address - Phone:978-521-8108
Mailing Address - Fax:978-521-8372
Practice Address - Street 1:288 GROVELAND STREET
Practice Address - Street 2:C-3
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830
Practice Address - Country:US
Practice Address - Phone:978-521-8108
Practice Address - Fax:978-521-8372
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA79899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ14686Medicare ID - Type Unspecified
F84513Medicare UPIN