Provider Demographics
NPI:1871564369
Name:COOLEY-GUTH, CAROL M (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:COOLEY-GUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5800 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4116
Mailing Address - Country:US
Mailing Address - Phone:716-662-7337
Mailing Address - Fax:716-662-0641
Practice Address - Street 1:5800 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4116
Practice Address - Country:US
Practice Address - Phone:716-662-7337
Practice Address - Fax:716-662-0641
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01144045Medicaid
NY00010312001OtherUNIVERA HEALTHCARE
NY000510751001OtherBLUE CROSS BLUE SHIELD
NY1202809OtherINDEPENDENT HEALTH