Provider Demographics
NPI:1386976819
Name:CARL DILA MD LLC
Entity type:Organization
Organization Name:CARL DILA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-324-3504
Mailing Address - Street 1:70 MILL RIVER ST
Mailing Address - Street 2:SUITE LL3
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3725
Mailing Address - Country:US
Mailing Address - Phone:203-324-3504
Mailing Address - Fax:203-969-1392
Practice Address - Street 1:70 MILL RIVER ST
Practice Address - Street 2:SUITE LL3
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3725
Practice Address - Country:US
Practice Address - Phone:203-324-3504
Practice Address - Fax:203-969-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019967207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB37913Medicare PIN