Provider Demographics
NPI:1124253828
Name:ILZARBE, CAROL MICHELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MICHELLE
Last Name:ILZARBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1612
Mailing Address - Country:US
Mailing Address - Phone:917-673-1602
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:860-545-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics