Provider Demographics
NPI:1427163310
Name:CARL, GARY HUDSON (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:HUDSON
Last Name:CARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:623 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1532
Practice Address - Country:US
Practice Address - Phone:716-701-1818
Practice Address - Fax:716-701-1820
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243986208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02878935Medicaid
NY1914267OtherIHA
BA0290OtherMEDICARE GROUP
NY02878935Medicaid
NY1914267OtherIHA
BA0290OtherMEDICARE GROUP
E36346Medicare UPIN