Provider Demographics
NPI:1114165115
Name:VALDIVIEZO SCHLOMP, CAROLINA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:ISABEL
Last Name:VALDIVIEZO SCHLOMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 EASTERN AVE
Mailing Address - Street 2:301 BUILDING, SUITE 2400
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-0724
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:301 BUILDING, SUITE 2400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69998207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD029336900Medicaid
MD029336900Medicaid