Provider Demographics
NPI:1073589396
Name:WILLIAMS, CARLA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5329
Practice Address - Country:US
Practice Address - Phone:203-869-7080
Practice Address - Fax:203-869-7034
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031982174400000X
NY203942-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2647207OtherAETNA
CTP696779OtherOXFORD
CT031982OtherCONNECTICARE
CTCV5863OtherHEALTHNET
CT010031982CT01OtherANTHEM BCBS OF CT
CTG95390Medicare UPIN