Provider Demographics
NPI:1396725594
Name:FLORES, CARLOS I (MD,PC)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:I
Last Name:FLORES
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 SHENANGO RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1177
Mailing Address - Country:US
Mailing Address - Phone:724-658-6450
Mailing Address - Fax:724-658-0968
Practice Address - Street 1:11 SHENANGO RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1177
Practice Address - Country:US
Practice Address - Phone:724-658-6450
Practice Address - Fax:724-658-0968
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036811L2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019627070001Medicaid
PAE63269Medicare UPIN