Healthcare Provider Details

I. General information

NPI: 1467511568
Provider Name (Legal Business Name): CARLOS ANTONIO HERNANDEZ-AVILA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 RUSSELL ROAD CEDARCREST HOSPITAL HUMAN RESOURCES
NEWINGTON CT
06111
US

IV. Provider business mailing address

525 RUSSELL ROAD CEDARCREST HOSPITAL HUMAN RESOURCES
NEWINGTON CT
06111
US

V. Phone/Fax

Practice location:
  • Phone: 860-666-7621
  • Fax: 860-594-4900
Mailing address:
  • Phone: 860-666-7621
  • Fax: 860-594-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number035921
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number035921
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number035921
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: