Provider Demographics
NPI:1164445649
Name:SICILIA, CARLOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:SICILIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2544 COURT DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3450
Mailing Address - Country:US
Mailing Address - Phone:704-864-7821
Mailing Address - Fax:704-865-0519
Practice Address - Street 1:2544 COURT DR
Practice Address - Street 2:SUITE G
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-864-7821
Practice Address - Fax:704-865-0519
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38440208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN38440OtherSC MEDICAID
NC8976148Medicaid
SCN38440OtherSC MEDICAID
E24332Medicare UPIN