Provider Demographics
NPI:1871571349
Name:GARCIA, CAROLYN LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:LOUISE
Last Name:GARCIA
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 1:350 SOUTH 40TH STREET
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4915
Mailing Address - Country:US
Mailing Address - Phone:918-683-0753
Mailing Address - Fax:866-397-7556
Practice Address - Street 1:1141 ELDEN ST STE 300
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5572
Practice Address - Country:US
Practice Address - Phone:703-443-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29561207V00000X
VA010127440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200462080AMedicaid
OK200468380XMedicaid
ME000465101Medicare PIN
OK264302YKW9Medicare PIN
OK200468380XMedicaid