Provider Demographics
NPI:1013076322
Name:CARDOSO, CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:CARDOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-262-5867
Mailing Address - Fax:860-262-5850
Practice Address - Street 1:SILVER STREET
Practice Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7023
Practice Address - Country:US
Practice Address - Phone:860-262-5867
Practice Address - Fax:860-262-5850
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0233722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F08267Medicare UPIN