Healthcare Provider Details

I. General information

NPI: 1669464384
Provider Name (Legal Business Name): CARLA Y WILES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 FREEDOM PLAINS RD SUITE 120
POUGHKEEPSIE NY
12603-2689
US

IV. Provider business mailing address

488 FREEDOM PLAINS RD SUITE 120
POUGHKEEPSIE NY
12603-2689
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-6233
  • Fax: 845-452-6516
Mailing address:
  • Phone: 845-452-6233
  • Fax: 845-452-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number227365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: