Basic Information
| Provider Information | |||||||||
| NPI: | 1720066467 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CAROLAN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 THEALL RD | ||||||||
| Address2: | |||||||||
| City: | RYE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105801404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148488800 | ||||||||
| FaxNumber: | 9148488801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 THEALL RD | ||||||||
| Address2: | |||||||||
| City: | RYE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105801404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148488800 | ||||||||
| FaxNumber: | 9148488801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 028686 | CT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 174162-1 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | 174162 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | 207VF0040X | 028686 | CT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01074822 | 05 | NY | MEDICAID | 174162-1 | 01 | NY | WORKERS COMPENSATION | OTHER |