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General NPI Number Information
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NPI Number | 1255730537
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Entity Type | Individual
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Provider Name | CARLA V SHILLER MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 12 STONECROFT DR
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City | EASTON
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State | PA
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Zip | 18045-2862
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Country | US
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Telephone | 908-391-2548
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | CHANGEWATER
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State | NJ
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Zip | 07831-0014
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Country | US
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Telephone | 908-391-2548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA066807000
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License Number State | NJ
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