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General NPI Number Information
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NPI Number | 1619194065
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Entity Type | Individual
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Provider Name | CARLON M COLKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 195 FIELD POINT RD
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City | GREENWICH
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State | CT
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Zip | 06830-6441
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Country | US
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Telephone | 203-625-9608
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Fax | 203-629-0589
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Provider Business Mailing Address
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Address Line | 195 FIELD POINT RD
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City | GREENWICH
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State | CT
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Zip | 06830-6441
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Country | US
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Telephone | 203-625-9608
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Fax | 203-629-0589
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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 | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | 034815
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License Number State | CT
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