Provider Demographics
NPI:1154322667
Name:DOOLAN, CARRIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:DOOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 57TH ST
Mailing Address - Street 2:1231
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10107-0001
Mailing Address - Country:US
Mailing Address - Phone:212-247-7546
Mailing Address - Fax:516-371-6083
Practice Address - Street 1:250 W 57TH ST
Practice Address - Street 2:1231
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0001
Practice Address - Country:US
Practice Address - Phone:212-247-7546
Practice Address - Fax:516-371-6083
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY564621Medicare ID - Type Unspecified
NYQ27626Medicare UPIN