Provider Demographics
NPI:1144259235
Name:BIGELOW, CAROLYN L (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:L
Last Name:BIGELOW
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 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DEPT OF MEDICINE/DIVISION OF HEMATOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-984-5615
Mailing Address - Fax:601-984-5689
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE/DIVISION OF HEMATOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5615
Practice Address - Fax:601-984-5689
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08700207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1691313Medicaid
MS0019223Medicaid
MSP01236764OtherRAILROAD MEDICARE PTAN
MSP01236764OtherRAILROAD MEDICARE PTAN
MS302I827204Medicare PIN
LA1691313Medicaid
MSA06377Medicare UPIN
MS0019223Medicaid