Provider Demographics
NPI:1194096248
Name:GIRALDO VANEGAS, CARLOS E (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:GIRALDO VANEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:E
Other - Last Name:GIRALDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:680 E FREMONT MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2309
Mailing Address - Country:US
Mailing Address - Phone:402-815-7120
Mailing Address - Fax:402-721-5230
Practice Address - Street 1:680 E FREMONT MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2309
Practice Address - Country:US
Practice Address - Phone:402-815-7120
Practice Address - Fax:402-721-5230
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine