Healthcare Provider Details

I. General information

NPI: 1417183286
Provider Name (Legal Business Name): CARTER FRANKLIN DILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PARK AVE 15N
NEW YORK NY
10016-3801
US

IV. Provider business mailing address

666 W 188TH ST APT 2L
NEW YORK NY
10040-4417
US

V. Phone/Fax

Practice location:
  • Phone: 917-553-5342
  • Fax:
Mailing address:
  • Phone: 917-553-5342
  • Fax: 212-683-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number255133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: