Healthcare Provider Details

I. General information

NPI: 1942282686
Provider Name (Legal Business Name): CARRIE A REDLICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COLLEGE ST RM 366
NEW HAVEN CT
06510-2483
US

IV. Provider business mailing address

135 COLLEGE ST RM 366
NEW HAVEN CT
06510-2483
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2817
  • Fax: 203-785-7391
Mailing address:
  • Phone: 203-785-2817
  • Fax: 203-785-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number025863
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number025863
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: