Provider Demographics
NPI:1164596771
Name:REMEDIOS-CARBONE, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:REMEDIOS-CARBONE
Suffix:
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:PMB 140 APARTADO 2000
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715
Mailing Address - Country:US
Mailing Address - Phone:787-813-4401
Mailing Address - Fax:787-813-4403
Practice Address - Street 1:EDIF PARRAS # 203
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-813-4401
Practice Address - Fax:787-813-4403
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR102362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3600009OtherID PROVIDER HUMANA
PR600705OtherID PROVIDER MMM
PR2483OtherID PROVIDER PREFERRED
PR4160-5OtherID PROVIDER PROSAM
PR82550OtherID PROVIDER TRIPLE S
PR069447OtherID PROVIDER CRUZ AZUL
PR3600009OtherID PROVIDER HUMANA
PRF01061Medicare UPIN