Provider Demographics
NPI:1225072770
Name:CARLO, WALDEMAR ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:ALBERTO
Last Name:CARLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WALLY
Other - Middle Name:A
Other - Last Name:CARLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 6TH AVE S STE 9380
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1802
Mailing Address - Country:US
Mailing Address - Phone:205-934-4680
Mailing Address - Fax:
Practice Address - Street 1:1700 6TH AVE S STE 9380
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1802
Practice Address - Country:US
Practice Address - Phone:205-934-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL155932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114022Medicaid
AL2407OtherHEALTHSPRING
AL4198243OtherAETNA
AL4710032OtherUHC
C03097OtherVIVA
AL00485196XOtherGEORGIA MEDICAID
510-83126OtherBC BS
AL2407OtherHEALTHSPRING