Provider Demographics
NPI:1639574221
Name:PINA PARKER, CAROL PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:PATRICIA
Last Name:PINA PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:PATRICIA
Other - Last Name:PINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4200
Mailing Address - Fax:302-421-9743
Practice Address - Street 1:701 N CLAYTON ST STE 400
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-421-9700
Practice Address - Fax:302-421-9743
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-26
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012081208000000X
OH35.140477208000000X
WV30014208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics