1396725594 NPI number — DR. CARLOS I FLORES M.D.,PC

Table of content: DR. CARLOS I FLORES M.D.,PC (NPI 1396725594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396725594 NPI number — DR. CARLOS I FLORES M.D.,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLORES
Provider First Name:
CARLOS
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,PC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396725594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 SHENANGO RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16105-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-658-6450
Provider Business Mailing Address Fax Number:
724-658-0968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 SHENANGO RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-658-6450
Provider Business Practice Location Address Fax Number:
724-658-0968
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  MD036811L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1019627070001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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