Provider Demographics
NPI:1821309972
Name:FONSECA VALENCIA, CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:FONSECA VALENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:FONSECA
Other - Last Name:SCULLION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:94 ANGELL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1211
Mailing Address - Country:US
Mailing Address - Phone:919-274-5052
Mailing Address - Fax:919-371-5462
Practice Address - Street 1:94 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1211
Practice Address - Country:US
Practice Address - Phone:919-274-5052
Practice Address - Fax:919-371-5462
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14725207R00000X
MA283408207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine