Provider Demographics
NPI:1962665737
Name:ELGUERO, CARLOS LUCIEN (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:LUCIEN
Last Name:ELGUERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:391 MYRTLE AVENUE
Practice Address - Street 2:SUITE 4A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-207-2273
Practice Address - Fax:518-207-2293
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2015-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY249373207Q00000X
OH35.096829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02986249Medicaid
OH3153215Medicaid
OH3153215Medicaid
OH4320282Medicare PIN
OH4320281Medicare PIN
NYRB8844Medicare PIN