Provider Demographics
NPI:1255366415
Name:DILLMAN, CARL EDWARD JR (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:EDWARD
Last Name:DILLMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-948-2232
Mailing Address - Fax:812-945-0869
Practice Address - Street 1:2109 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-948-2232
Practice Address - Fax:812-945-0869
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019402A207RC0000X
KY21978207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100116090AMedicaid
KY64219785Medicaid
D69507Medicare UPIN
KY64219785Medicaid
IN100116090AMedicaid