Provider Demographics
NPI:1386664738
Name:DICENTA, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:DICENTA
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:PO BOX 1027
Mailing Address - Street 2:8 SOUTH MORRIS ST, STE 203
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801
Mailing Address - Country:US
Mailing Address - Phone:973-328-6600
Mailing Address - Fax:973-361-0599
Practice Address - Street 1:8 SOUTH MORRIS ST
Practice Address - Street 2:STE 203 DOVER MEDICAL BUILDING
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801
Practice Address - Country:US
Practice Address - Phone:973-328-6600
Practice Address - Fax:973-361-0599
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03835500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3460509Medicaid
E55134Medicare UPIN
NJI615626Medicare ID - Type Unspecified