Provider Demographics
NPI:1548225253
Name:GARCIA, CAROLYN R (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:GARCIA
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 1:501 VAN BUREN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1593
Mailing Address - Country:US
Mailing Address - Phone:419-436-0840
Mailing Address - Fax:419-436-0436
Practice Address - Street 1:501 VAN BUREN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1593
Practice Address - Country:US
Practice Address - Phone:419-436-0840
Practice Address - Fax:419-436-0436
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087291208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGOtherAETNA
OHPENDINGOtherMMOH
OHPENDINGOtherTRICARE
OHPENDINGMedicaid
OHPENDINGOtherUHC
OHPENDINGOtherPARAMOUNT
OHPENDINGOtherANTHEM
OHPENDINGOtherANTHEM
OHH53372Medicare UPIN