Individual
CAROLYN A STICKNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
333 LONGWOOD AVE, LO 011, CRITICAL CARE MEDICINE, BOSTON CHILDREN'S HOSPITAL, BOSTON, MA 02115-5724
(617) 355-4480
Mailing address
333 LONGWOOD AVE, LO 011, MEDICINE CRITICAL CARE CHILDREN'S HOSPITAL BOSTON, BOSTON, MA 02115-5724
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
57.009030
OH
208000000X
Pediatrics Physician
57.009030
OH
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
240053
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
35-091362
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2839192
—
OH
01
—
9959153
AETNA
OH
Enumeration date
05/09/2007
Last updated
08/07/2015
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