Provider Demographics
NPI:1598983454
Name:WILSON, CAROLYN ZIEGLER (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ZIEGLER
Last Name:WILSON
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 1:2960 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2344
Mailing Address - Country:US
Mailing Address - Phone:510-848-3250
Mailing Address - Fax:510-843-4675
Practice Address - Street 1:2960 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2344
Practice Address - Country:US
Practice Address - Phone:510-848-3250
Practice Address - Fax:510-843-4675
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG571402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1850519OtherMEDICAL
CAE41520Medicare UPIN
CA00G571400Medicare ID - Type Unspecified