Individual
DR. MARIO CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1676 SUNSET AVE, 4TH FLOOR, UTICA, NY 13502
(315) 624-4690
(315) 624-4840
Mailing address
2209 GENESEE STREET, BUSINESS OFFICE, UTICA, NY 13501-5930
(315) 801-3282
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
213540
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01976636
—
NY
Enumeration date
10/16/2006
Last updated
03/23/2016
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