Provider Demographics
NPI:1073596011
Name:CEREZO, CAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:CEREZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:DIVISION OF PEDIATRIC GASTROENTEROLOGY & NUTRITION MPS
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-2827
Mailing Address - Fax:401-444-8748
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:DIVISION OF PEDIATRIC GASTROENTEROLOGY & NUTRITION
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-2827
Practice Address - Fax:401-444-8748
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD111322080P0206X
MA2366792080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7010598Medicaid
RI007057100Medicare PIN
RIH91307Medicare UPIN