Provider Demographics
NPI:1407300858
Name:ESCUDERO, CAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:ESCUDERO
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 1:240 HEATH ST
Mailing Address - Street 2:PH 16
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1149
Mailing Address - Country:US
Mailing Address - Phone:617-712-8043
Mailing Address - Fax:
Practice Address - Street 1:240 HEATH ST
Practice Address - Street 2:PH 16
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-1149
Practice Address - Country:US
Practice Address - Phone:617-712-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2665932080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology