Healthcare Provider Details

I. General information

NPI: 1720070741
Provider Name (Legal Business Name): TERESA CATHERINE CARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WARREN ST
NEW YORK NY
10007-0029
US

IV. Provider business mailing address

11 PARK PL
NEW YORK NY
10007-2801
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-7666
  • Fax: 212-202-7988
Mailing address:
  • Phone: 212-226-7666
  • Fax: 212-202-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: