Provider Demographics
NPI:1861636771
Name:VIDAL, CAROLINA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:VIDAL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:VIDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1800 ORLEANS ST
Mailing Address - Street 2:BLOOMBERG 12N
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:BLOOMBERG 12N
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-614-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD724642084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry