Provider Demographics
NPI:1578770004
Name:GOPEZ, CARLO E (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:E
Last Name:GOPEZ
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 1:138 CATHEDRAL ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5562
Mailing Address - Country:US
Mailing Address - Phone:410-398-3041
Mailing Address - Fax:410-392-6853
Practice Address - Street 1:138 CATHEDRAL ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5562
Practice Address - Country:US
Practice Address - Phone:410-398-3041
Practice Address - Fax:410-392-6853
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065902207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00415424OtherMEDICARE RAILROAD
MD483P927GMedicare PIN