Provider Demographics
NPI:1023084696
Name:WESSON, KAREN M (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:WESSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 NORTHERN BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5317
Mailing Address - Country:US
Mailing Address - Phone:516-829-0050
Mailing Address - Fax:516-829-0052
Practice Address - Street 1:1010 NORTHERN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5317
Practice Address - Country:US
Practice Address - Phone:516-829-0050
Practice Address - Fax:516-829-0052
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223800173000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCI8847OtherRAILROAD MEDICARE
NY3K1591Medicare PIN
NYI00362Medicare UPIN