Provider Demographics
NPI:1548519614
Name:WESTFALL, CARLENE (MD)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:
Other - Last Name:DENIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:COLLEGE CORNER
Mailing Address - State:OH
Mailing Address - Zip Code:45003-0641
Mailing Address - Country:US
Mailing Address - Phone:513-436-6577
Mailing Address - Fax:513-402-8270
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLEGE CORNER
Practice Address - State:OH
Practice Address - Zip Code:45003-9061
Practice Address - Country:US
Practice Address - Phone:513-834-7063
Practice Address - Fax:513-873-1567
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY455252081P2900X
OH35.137242207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100230570Medicaid
KY7100230570Medicaid