Provider Demographics
NPI:1851335665
Name:CARRASCO, LEONOR C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONOR
Middle Name:C
Last Name:CARRASCO
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:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-1073
Mailing Address - Country:US
Mailing Address - Phone:252-523-5461
Mailing Address - Fax:252-523-0471
Practice Address - Street 1:905 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501
Practice Address - Country:US
Practice Address - Phone:252-523-5461
Practice Address - Fax:252-523-0471
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30999207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921358Medicaid
C50378Medicare UPIN
NC8921358Medicaid