Provider Demographics
NPI:1679802987
Name:MCFARLANE, CAROLYN GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:GAIL
Last Name:MCFARLANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:GAIL
Other - Last Name:SENAVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-7350
Mailing Address - Fax:208-367-3951
Practice Address - Street 1:1055 N CURTIS ROAD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-367-7350
Practice Address - Fax:208-367-3951
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-48401207R00000X
IDM-13405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52525562Medicaid
CO023596OtherKAISER COMMERCIAL NUMBER
CO313367YK5YMedicare PIN