Provider Demographics
NPI:1518997816
Name:MILINDA R.CARSON MD, PA
Entity Type:Organization
Organization Name:MILINDA R.CARSON MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-246-6999
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05970500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6939902Medicaid
NJ6939902Medicaid
NJ858353Medicare ID - Type Unspecified
NJ858353YBA7Medicare PIN