Provider Demographics
NPI:1235199365
Name:FLORES, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:FLORES
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 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-1000
Mailing Address - Fax:
Practice Address - Street 1:5936 LIMESTONE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8905
Practice Address - Country:US
Practice Address - Phone:302-234-5800
Practice Address - Fax:302-234-2380
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00051662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000819701Medicaid
990010688OtherRAILROAD MEDICARE #
DE002429X32Medicare PIN
G60625Medicare UPIN
DE0000819701Medicaid