Provider Demographics
NPI:1427268127
Name:CARL MCDOUGALL, MD PC
Entity type:Organization
Organization Name:CARL MCDOUGALL, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CODING
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCS-P
Authorized Official - Phone:845-634-6500
Mailing Address - Street 1:38 E 57TH ST FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-8515
Mailing Address - Country:US
Mailing Address - Phone:845-634-6500
Mailing Address - Fax:845-634-9424
Practice Address - Street 1:17 SQUADRON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5214
Practice Address - Country:US
Practice Address - Phone:845-634-6500
Practice Address - Fax:845-634-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEK881Medicare ID - Type Unspecified