Provider Demographics
NPI:1881742278
Name:CARLOS, ALICIA T (DO)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:T
Last Name:CARLOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:324 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2008
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY026312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100131950Medicaid
KY0332017Medicare ID - Type UnspecifiedMEDICARE
KY1331532Medicare ID - Type UnspecifiedMEDICARE
KY0338316Medicare ID - Type UnspecifiedMEDICARE
KY0331825Medicare ID - Type UnspecifiedMEDICARE
KY30615058Medicaid
KY3315Medicare ID - Type UnspecifiedMEDICARE