Provider Demographics
NPI:1124230453
Name:RETAMERO, CAROLINA I (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:I
Last Name:RETAMERO
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:3/208
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-0400
Mailing Address - Fax:
Practice Address - Street 1:100 E LEHIGH AVE # MAB
Practice Address - Street 2:SUITE 105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-8496
Practice Address - Fax:215-707-4086
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4338712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022244620001Medicaid
PA138153Medicare PIN