Provider Demographics
NPI:1073141511
Name:KIRKPATRICK, CARSON THOMAS (MD)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:THOMAS
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PERRY ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2760
Mailing Address - Country:US
Mailing Address - Phone:713-825-6334
Mailing Address - Fax:
Practice Address - Street 1:3514 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1402
Practice Address - Country:US
Practice Address - Phone:866-633-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329660207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology