Healthcare Provider Details

I. General information

NPI: 1093799579
Provider Name (Legal Business Name): CARLINE ST LOUIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 CHURCH AVENUE
BROOKLYN NY
11203
US

IV. Provider business mailing address

5800 3RD AVE
BROOKLYN NY
11220-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-2197
  • Fax: 718-940-2914
Mailing address:
  • Phone: 718-630-6180
  • Fax: 718-630-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME74443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: