MEDICARE: CARL MCDOUGALL, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	156743	NY

General Provider Information

NPI Number	:	1427268127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL MCDOUGALL, MD PC

Provider Business Mailing Address
First Line	:	38 E 57TH ST FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-8515
Country	:	US
Telephone Number	:	845-634-6500
Fax Number	:	845-634-9424

Provider Business Practice Location Address
First Line	:	17 SQUADRON BLVD
Second Line	:	SUITE 400
City	:	NEW CITY
State	:	NY
Zip	:	10956-5214
Country	:	US
Telephone Number	:	845-634-6500
Fax Number	:	845-634-9424

Authorized Official
Title or Position	:	DIRECTOR CODING
Name	:	MARIE FARRELL
Credential	:	RN CCS-P
Telephone Number	:	845-634-6500

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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