Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carl Terence Mickman, MD

Individual provider Emergency Medicine Physician · NPI 1124445242

Carl Terence Mickman, MD is an Emergency Medicine in New York, New York. Graduated from Louisiana State University School of Medicine in New Orleans in 2014, 12 years ago. Practices with Professional Emergency Medicine Management -- Lake Charles LLC, a 19-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Louisiana and New York.

Years since qualifying
12
Trained at
Louisiana State University School of Medicine in New Orleans
Licensed in
LA, NY
In the registry since
2014
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1 Gustave L Levy Pl Box 1149
New York, NY 10029-6504
Phone: (612) 618-7945
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1500 N James St, Rome, NY 13440-2844 — (315) 338-7035

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 294040 (NY)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 326621 (LA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (NY)

Record details

NPI number1124445242
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 26, 2014
Last updated in NPPESJune 24, 2022
Certification dateJune 24, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolLOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
Graduated 2014 (12 years in practice)
Group practice Professional Emergency Medicine Management -- Lake Charles Llc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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