Provider Demographics
NPI:1245236447
Name:CARNEY, WILFRED I JR (MD)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:I
Last Name:CARNEY
Suffix:JR
Gender:M
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:PO BOX 1677
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-1677
Mailing Address - Country:US
Mailing Address - Phone:413-445-6420
Mailing Address - Fax:413-499-4907
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-445-6420
Practice Address - Fax:413-499-4907
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD051492086S0129X
MA350102086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001005Medicaid
RI007056915Medicare PIN
C90063Medicare UPIN
RI9001005Medicaid