Provider Demographics
NPI:1952640914
Name:CARLOS N PATALINGHUG SR., M.D. LLC
Entity Type:Organization
Organization Name:CARLOS N PATALINGHUG SR., M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATALINGHUG
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD, LLC
Authorized Official - Phone:410-354-4100
Mailing Address - Street 1:3721 POTEE ST
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1717
Mailing Address - Country:US
Mailing Address - Phone:410-354-4100
Mailing Address - Fax:410-354-4350
Practice Address - Street 1:3721 POTEE ST
Practice Address - Street 2:SUITE #6
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1717
Practice Address - Country:US
Practice Address - Phone:410-354-4100
Practice Address - Fax:410-354-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18426207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD18426OtherLICENSE
MDB69672Medicare UPIN