Basic Information
| Provider Information | |||||||||
| NPI: | 1508852351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERNE | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 MALTESE DR | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453424774 | ||||||||
| FaxNumber: | 8458187555 | ||||||||
| Practice Location | |||||||||
| Address1: | 13933 17TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DADE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335254604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525676763 | ||||||||
| FaxNumber: | 3525672146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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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 | 207P00000X | MD053982L | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 121194 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME77701 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001487260 | 05 | PA | MEDICAID | 819001 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 000534418 | 01 | PA | BLUE SHIELD | OTHER | 2904218 | 05 | OH | MEDICAID | P00260114 | 01 | PA | RAILROAD MEDICARE | OTHER | 0014872600008 | 05 | PA | MEDICAID | 3810016824 | 05 | WV | MEDICAID |