Provider Demographics
NPI:1578670261
Name:DILA, CARL (M D)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:DILA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:70 MILL RIVER ST
Mailing Address - Street 2:LL3
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3725
Mailing Address - Country:US
Mailing Address - Phone:203-324-3504
Mailing Address - Fax:203-969-1392
Practice Address - Street 1:70 MILL RIVER ST
Practice Address - Street 2:LL3
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3725
Practice Address - Country:US
Practice Address - Phone:203-324-3504
Practice Address - Fax:203-969-1392
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT019967207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB37913Medicare UPIN