Provider Demographics
NPI:1861499915
Name:FERNANDEZ, CAROLINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:E
Last Name:FERNANDEZ
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 15976
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80935-5976
Mailing Address - Country:US
Mailing Address - Phone:716-903-7061
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIRCLE
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7160
Practice Address - Fax:719-526-4903
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0170207R00000X
NY251860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030198803Medicaid
TX8J8950OtherBLUE CROSS
TX030198803Medicaid
TXH27765Medicare UPIN