Provider Demographics
NPI:1275572034
Name:CARSON, MILINDA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MILINDA
Middle Name:RUTH
Last Name:CARSON
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 1:203 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4717
Mailing Address - Country:US
Mailing Address - Phone:973-246-6999
Mailing Address - Fax:973-685-7340
Practice Address - Street 1:203 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4717
Practice Address - Country:US
Practice Address - Phone:973-246-6999
Practice Address - Fax:973-685-7340
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05970500207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6939902Medicaid
NJ858353Medicare PIN
NJ6939902Medicaid
NJ858353YBA7Medicare PIN