Provider Demographics
NPI:1316033905
Name:FONSECA, CARMEN MARIA (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIA
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVENUE/J3-5
Mailing Address - Street 2:CLEVELAND CLINIC
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-445-3991
Mailing Address - Fax:216-636-6958
Practice Address - Street 1:9500 EUCLID AVENUE/J3-5
Practice Address - Street 2:CLEVELAND CLINIC DEPT. CARDIOVASCULAR MEDICINE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-445-3991
Practice Address - Fax:216-636-6958
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061401F207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0828439Medicaid
OH0828439Medicaid
OHFO0695574Medicare UPIN
OHE92017Medicare UPIN