Provider Demographics
NPI:1457335630
Name:CARO, MARICELINA (MD)
Entity Type:Individual
Prefix:
First Name:MARICELINA
Middle Name:
Last Name:CARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARICELINA
Other - Middle Name:CARO
Other - Last Name:KNOTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 NEW PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1160
Mailing Address - Country:US
Mailing Address - Phone:919-800-9174
Mailing Address - Fax:
Practice Address - Street 1:301 NEW PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-1160
Practice Address - Country:US
Practice Address - Phone:919-800-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141143261QM0850X
NC200201346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200474630Medicaid
IN940550B1Medicare PIN
IN200474630Medicaid