Healthcare Provider Details

I. General information

NPI: 1538196795
Provider Name (Legal Business Name): ROBERT CARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLD WATERBURY RD
SOUTHBURY CT
06488-3848
US

IV. Provider business mailing address

22 OLD WATERBURY RD
SOUTHBURY CT
06488-3848
US

V. Phone/Fax

Practice location:
  • Phone: 203-262-4200
  • Fax:
Mailing address:
  • Phone: 203-262-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number041703
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number041703
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: