Provider Demographics
NPI:1477500072
Name:OLNICK, CAROL LY NN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LY NN
Last Name:OLNICK
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 1:29 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4068
Mailing Address - Country:US
Mailing Address - Phone:603-577-2273
Mailing Address - Fax:603-579-5191
Practice Address - Street 1:29 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4068
Practice Address - Country:US
Practice Address - Phone:603-577-2273
Practice Address - Fax:603-579-5191
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE3787Medicare PIN
G09290Medicare UPIN
NHRE3787Medicare PIN