Provider Demographics
NPI:1861630261
Name:CARLOS E. COVARRUBIAS, MD & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CARLOS E. COVARRUBIAS, MD & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:SAYIL
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-589-9480
Mailing Address - Street 1:8121 GEORGIA AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4933
Mailing Address - Country:US
Mailing Address - Phone:301-589-9480
Mailing Address - Fax:301-589-3872
Practice Address - Street 1:8121 GEORGIA AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4933
Practice Address - Country:US
Practice Address - Phone:301-589-9480
Practice Address - Fax:301-589-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD921346500Medicaid
MD887859Medicare PIN
MD921346500Medicaid