Provider Demographics
NPI:1245417799
Name:CARRENO, ELMER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELMER
Middle Name:
Last Name:CARRENO
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 1:2943 SAINT HELEN CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2467
Mailing Address - Country:US
Mailing Address - Phone:301-460-9289
Mailing Address - Fax:
Practice Address - Street 1:2943 SAINT HELEN CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2467
Practice Address - Country:US
Practice Address - Phone:301-460-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12495208600000X
MDD0025996208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC593996Medicaid
DC593996Medicaid
DCC88661Medicare UPIN