Provider Demographics
NPI:1689645780
Name:VASQUEZ, CARLOS ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ARTURO
Last Name:VASQUEZ
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 1:2101 JACOB ST
Mailing Address - Street 2:STE 302
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-232-1122
Mailing Address - Fax:304-234-1864
Practice Address - Street 1:2101 JACOB ST
Practice Address - Street 2:STE 302
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-232-1122
Practice Address - Fax:304-234-1864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10651207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Not Answered207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9304101Medicare ID - Type Unspecified
D18482Medicare UPIN