Provider Demographics
NPI:1669464384
Name:WILES, CARLA Y (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:Y
Last Name:WILES
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 1:488 FREEDOM PLAINS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2689
Mailing Address - Country:US
Mailing Address - Phone:845-452-6233
Mailing Address - Fax:845-452-6516
Practice Address - Street 1:488 FREEDOM PLAINS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2689
Practice Address - Country:US
Practice Address - Phone:845-452-6233
Practice Address - Fax:845-452-6516
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001947397 0006Medicaid
NY2380454Medicaid
PA069970QLQMedicare ID - Type Unspecified
NY77S731Medicare ID - Type Unspecified
NY2380454Medicaid