Healthcare Provider Details

I. General information

NPI: 1639143324
Provider Name (Legal Business Name): KAROLYN R KERR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 2ND AVE
NEW YORK NY
10017-5906
US

IV. Provider business mailing address

751 2ND AVE
NEW YORK NY
10017-5906
US

V. Phone/Fax

Practice location:
  • Phone: 212-599-5555
  • Fax: 212-599-5554
Mailing address:
  • Phone: 212-599-5555
  • Fax: 212-599-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number205509
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number205509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: