Individual
CAROLYN RAE TIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2249 STATE ROUTE 86 STE 2, SARANAC LAKE, NY 12983-5644
(518) 354-5353
(518) 354-8153
Mailing address
2249 STATE ROUTE 86 STE 2, SARANAC LAKE, NY 12983-5644
(518) 354-5353
(518) 354-8153
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
013307
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013307
STATE LICENSE
NY
Enumeration date
09/09/2009
Last updated
04/02/2025
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