Provider Demographics
NPI:1235136813
Name:PATALINGHUG, CARLOS N SR (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:N
Last Name:PATALINGHUG
Suffix:SR
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 1:5410 RITCHIE HWY
Mailing Address - Street 2:STE B
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3069
Mailing Address - Country:US
Mailing Address - Phone:410-354-4100
Mailing Address - Fax:410-354-4350
Practice Address - Street 1:5410 RITCHIE HWY
Practice Address - Street 2:STE B
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3069
Practice Address - Country:US
Practice Address - Phone:410-354-4100
Practice Address - Fax:410-354-4350
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4379833OtherAETNA
6681CNOtherBLUE CROSS
4379833OtherAETNA
B69672Medicare UPIN