Provider Demographics
NPI:1306839469
Name:COVARRUBIAS PONCE, CARLOS EUGENIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EUGENIO
Last Name:COVARRUBIAS PONCE
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 1:8121 GEORGIA AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4933
Mailing Address - Country:US
Mailing Address - Phone:301-589-9480
Mailing Address - Fax:301-589-3872
Practice Address - Street 1:8121 GEORGIA AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4933
Practice Address - Country:US
Practice Address - Phone:301-589-9480
Practice Address - Fax:301-589-3872
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD921346500Medicaid
MDD0048290OtherMEDICAL LICENSE
MDD0048290OtherMEDICAL LICENSE