Provider Demographics
NPI:1538135942
Name:ESPIRITU, MARIA CARMEN EDAUGAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA CARMEN
Middle Name:EDAUGAL
Last Name:ESPIRITU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARIA CARMEN
Other - Middle Name:CASTILLO
Other - Last Name:EDAUGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2425 N CENTER ST
Mailing Address - Street 2:370
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1320
Mailing Address - Country:US
Mailing Address - Phone:704-269-9982
Mailing Address - Fax:828-322-7921
Practice Address - Street 1:715 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:SUITE 204
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9290
Practice Address - Country:US
Practice Address - Phone:888-898-7130
Practice Address - Fax:828-322-7921
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301457208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891352XMedicaid
NC200301457OtherNCMB
NC2337124OtherMEDICARE
NC891352XMedicaid