Provider Demographics
NPI:1043256290
Name:CARRON, CATHY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:ANNE
Last Name:CARRON
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 1:65 BROADWAY STE 1806
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2517
Mailing Address - Country:US
Mailing Address - Phone:212-784-0073
Mailing Address - Fax:212-784-0076
Practice Address - Street 1:65 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2503
Practice Address - Country:US
Practice Address - Phone:212-784-0073
Practice Address - Fax:212-784-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2024-04-24
Deactivation Date:2024-03-27
Deactivation Code:
Reactivation Date:2024-04-15
Provider Licenses
StateLicense IDTaxonomies
NY1676231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA61524Medicare UPIN