Provider Demographics
NPI:1932116985
Name:WILSON, CARLA S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:MSC08 4640
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-938-8465
Mailing Address - Fax:505-938-8414
Practice Address - Street 1:1001 WOODWARD PLACE NE
Practice Address - Street 2:TRICORE REFERENCE LABORATORIES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-0001
Practice Address - Country:US
Practice Address - Phone:505-938-8465
Practice Address - Fax:505-938-8414
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-182207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM302576Medicare PIN
NMNM302575Medicare PIN
NMNM302572Medicare PIN
NMNM302571Medicare PIN
NMNM302573Medicare PIN
NMNM302574Medicare PIN