Healthcare Provider Details

I. General information

NPI: 1851319321
Provider Name (Legal Business Name): INES M CARRASQUILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT. OF MEDICINE MEDICAL SERVICE GROUP-PALLIATIVE CARE 750 EAST ADAMS ST., 10TH FLOOR
SYRACUSE NY
13210
US

IV. Provider business mailing address

DEPT. OF MEDICINE MEDICAL SERVICE GROUP-PALLIATIVE CARE 750 EAST ADAMS ST., 10TH FLOOR
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-6098
  • Fax: 315-464-4761
Mailing address:
  • Phone: 315-464-6098
  • Fax: 315-464-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number83637
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number122279
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number163791
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: