MEDICARE: WILFRED I. CARNEY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	MD05149	RI
2	2086S0129X	Vascular Surgery Physician	35010	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245236447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILFRED I. CARNEY JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 1677
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01202-1677
Country	:	US
Telephone Number	:	413-445-6420
Fax Number	:	413-499-4907

Provider Business Practice Location Address
First Line	:	777 NORTH ST
Second Line	:	SUITE 407
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4147
Country	:	US
Telephone Number	:	413-445-6420
Fax Number	:	413-499-4907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/10/2011

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