Provider Demographics
NPI:1588640775
Name:DECARVALHO, CARLOS A, (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A,
Last Name:DECARVALHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4895 MONROE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4383
Mailing Address - Country:US
Mailing Address - Phone:419-475-4734
Mailing Address - Fax:419-475-5092
Practice Address - Street 1:4895 MONROE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4383
Practice Address - Country:US
Practice Address - Phone:419-475-4734
Practice Address - Fax:419-475-5092
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-5182-C2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-04-5182-COtherOHIO MEDICAL LICENSE
OH34145271700OtherWORKER'S COMP
OH0449205Medicaid
OH0449205Medicaid
OHAC9509336OtherDEA
OHA79778Medicare UPIN