Provider Demographics
NPI:1912290230
Name:OVERTON, CARLA BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:BROOKE
Last Name:OVERTON
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 1:909 W 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-5050
Mailing Address - Country:US
Mailing Address - Phone:315-598-6785
Mailing Address - Fax:
Practice Address - Street 1:909 W 1ST ST S
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-5050
Practice Address - Country:US
Practice Address - Phone:315-598-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program