Provider Demographics
NPI:1396702726
Name:GOMEZ-DI CESARE, CAROLINE M (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
Last Name:GOMEZ-DI CESARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:518-295-8521
Mailing Address - Fax:518-295-7911
Practice Address - Street 1:109 BAKER AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURGH
Practice Address - State:NY
Practice Address - Zip Code:12122
Practice Address - Country:US
Practice Address - Phone:518-827-7730
Practice Address - Fax:518-827-7731
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211403208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01880919Medicaid
NYBB2957Medicare ID - Type UnspecifiedUPSTATE
NY01880919Medicaid