Provider Demographics
NPI:1083774228
Name:MARRERO, CARLOS C SR (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:C
Last Name:MARRERO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366268
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6268
Mailing Address - Country:US
Mailing Address - Phone:787-274-0277
Mailing Address - Fax:787-765-2823
Practice Address - Street 1:CESAR GONZALEZ #463 URB ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-274-0277
Practice Address - Fax:787-765-2823
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8381207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1808OtherPALIC-PE
066733OtherCRUZ AZUL
9180014OtherHUMANA
27803MAOtherTS
28381OtherMCS
58376947OtherCIGNA
27803MAOtherTS
28381OtherMCS