Healthcare Provider Details

I. General information

NPI: 1316921844
Provider Name (Legal Business Name): CARLTON B BARNSWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 ELMONT RD
ELMONT NY
11003-3529
US

IV. Provider business mailing address

438 ELMONT RD
ELMONT NY
11003-3529
US

V. Phone/Fax

Practice location:
  • Phone: 516-328-8775
  • Fax: 516-328-8713
Mailing address:
  • Phone: 516-328-8775
  • Fax: 516-328-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number181883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: