Provider Demographics
NPI:1003999194
Name:MALDONADO ACEVEDO, CARLOS I SR (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:I
Last Name:MALDONADO ACEVEDO
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:#499 CAMINO DE CAMBALACHE
Mailing Address - Street 2:SABANERA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-598-6353
Mailing Address - Fax:787-765-2841
Practice Address - Street 1:CALLE GENERAL VALERO 1020 URG LAS DELICIAS
Practice Address - Street 2:RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-282-6534
Practice Address - Fax:787-765-2841
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-10-17
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Provider Licenses
StateLicense IDTaxonomies
PR8615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
500066EOtherMMM HEALTHCARE
29863Medicare ID - Type Unspecified
E42375Medicare UPIN