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General NPI Number Information
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NPI Number | 1821054313
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Entity Type | Individual
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Provider Name | CARLA LUISA PETTERKIN-CALDWELL MD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 451 CLARKSON AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-2057
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Country | US
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Telephone | 718-245-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 213 BROOKSIDE AVE
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City | ROOSEVELT
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State | NY
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Zip | 11575-1939
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Country | US
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Telephone | 516-377-6084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 190955
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License Number State | NY
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