Provider Demographics
NPI:1801237896
Name:DAUM, CARRYE LYNN (MD)
Entity type:Individual
Prefix:
First Name:CARRYE
Middle Name:LYNN
Last Name:DAUM
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 1:4199 GATEWAY BLVD STE 2400
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-7972
Mailing Address - Country:US
Mailing Address - Phone:812-858-4600
Mailing Address - Fax:812-858-4601
Practice Address - Street 1:4199 GATEWAY BLVD STE 2400
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7972
Practice Address - Country:US
Practice Address - Phone:812-858-4600
Practice Address - Fax:812-858-4601
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078481A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN637080003OtherMEDICARE