Provider Demographics
NPI:1740634880
Name:CERVANTES PACURUCU, CARMEN ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN ELENA
Middle Name:
Last Name:CERVANTES PACURUCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN ELENA
Other - Middle Name:
Other - Last Name:CERVANTES PACURUCU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GREENLEIGH AVE 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1830 E. MONUMENT ST.
Practice Address - Street 2:4TH FLOOR / SUITE 416
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2024-05-23
Deactivation Date:2016-11-28
Deactivation Code:
Reactivation Date:2016-12-16
Provider Licenses
StateLicense IDTaxonomies
MDD90474207V00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology